Provider Demographics
NPI:1366790537
Name:SPONDERWORKS CHILDRENS SERVICES
Entity type:Organization
Organization Name:SPONDERWORKS CHILDRENS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SPNDER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA; LEP
Authorized Official - Phone:310-521-0112
Mailing Address - Street 1:1536 W 25TH ST STE 172
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4415
Mailing Address - Country:US
Mailing Address - Phone:310-521-0112
Mailing Address - Fax:310-831-7291
Practice Address - Street 1:1520 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3602
Practice Address - Country:US
Practice Address - Phone:310-521-0112
Practice Address - Fax:310-831-7291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2348251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health