1780838235 NPI number — SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER - FSP

Table of content: MICHAEL ROBERT ROMANO BCBA (NPI 1225761323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780838235 NPI number — SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER - FSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER - FSP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780838235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14658 OXNARD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91411-3119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-785-0103
Provider Business Mailing Address Fax Number:
818-785-0145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14658 OXNARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91411-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-785-0103
Provider Business Practice Location Address Fax Number:
818-785-0145
Provider Enumeration Date:
11/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BALSAVAGE
Authorized Official First Name:
JENNA
Authorized Official Middle Name:
Authorized Official Title or Position:
FSP PROGRAM MANAGER
Authorized Official Telephone Number:
818-785-0103

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LCS 23834 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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