Provider Demographics
NPI:1487795035
Name:INTENSIVE OUTPATIENT EATING DISORDER PROGRAMS, INC,
Entity type:Organization
Organization Name:INTENSIVE OUTPATIENT EATING DISORDER PROGRAMS, INC,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MANICKMA
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:818-702-6322
Mailing Address - Street 1:6325 TOPANGA CANYON BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2006
Mailing Address - Country:US
Mailing Address - Phone:818-713-1312
Mailing Address - Fax:818-713-1311
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:STE. 305
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2006
Practice Address - Country:US
Practice Address - Phone:818-713-1312
Practice Address - Fax:818-713-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty