Basic Information
| Provider Information | |||||||||
| NPI: | 1487830725 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5935 VAN NUYS BLVD | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914013624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182851900 | ||||||||
| FaxNumber: | 8182851906 | ||||||||
| Practice Location | |||||||||
| Address1: | 6931 VAN NUYS BLVD | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189014830 | ||||||||
| FaxNumber: | 8187853446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2008 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | ROSENKJAR | ||||||||
| AuthorizedOfficialFirstName: | SERINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR: CASC | ||||||||
| AuthorizedOfficialTelephone: | 8182851900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | PSY18963 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.