Provider Demographics
NPI: | 1487079455 |
---|---|
Name: | THE CAMDEN CENTER, INC. |
Entity type: | Organization |
Organization Name: | THE CAMDEN CENTER, INC. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JASON |
Authorized Official - Middle Name: | ERIC |
Authorized Official - Last Name: | SCHIFFMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD, MA, MBA |
Authorized Official - Phone: | 844-422-6336 |
Mailing Address - Street 1: | 10780 SANTA MONICA BLVD |
Mailing Address - Street 2: | SUITE 105 |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90025-4749 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 844-422-6336 |
Mailing Address - Fax: | 888-887-2955 |
Practice Address - Street 1: | 10780 SANTA MONICA BLVD |
Practice Address - Street 2: | SUITE 105 |
Practice Address - City: | LOS ANGELES |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90025-4749 |
Practice Address - Country: | US |
Practice Address - Phone: | 844-422-6336 |
Practice Address - Fax: | 888-887-2955 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-02-26 |
Last Update Date: | 2019-04-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | MFC49040 | 101YA0400X, 101YM0800X |
CA | PSY25565 | 103TB0200X, 103TC0700X |
CA | LCS21488 | 1041C0700X, 171M00000X |
CA | MFC48114 | 106H00000X |
CA | AC11797 | 133NN1002X, 171100000X |
CA | A126101 | 2084P0800X |
CA | A112538 | 2084P0802X, 324500000X |
324500000X, 261QM0850X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 133NN1002X | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | Group - Multi-Specialty |
No | 171100000X | Other Service Providers | Acupuncturist | Group - Multi-Specialty | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | Group - Multi-Specialty |
No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Group - Multi-Specialty |