Provider Demographics
NPI:1063796308
Name:CRITTENTON SERVICES FOR CHILDREN AND FAMILIES
Entity type:Organization
Organization Name:CRITTENTON SERVICES FOR CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD AND FAMILY SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-269-5353
Mailing Address - Street 1:6911 BRENNER AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3416
Mailing Address - Country:US
Mailing Address - Phone:714-269-5353
Mailing Address - Fax:
Practice Address - Street 1:801 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3839
Practice Address - Country:US
Practice Address - Phone:714-269-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health