Provider Demographics
NPI:1083419279
Name:EARLY CHILDHOOD MENTAL HEALTH PROGRAM
Entity type:Organization
Organization Name:EARLY CHILDHOOD MENTAL HEALTH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MBA, AMFT
Authorized Official - Phone:510-367-9564
Mailing Address - Street 1:1726 SONOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-6012
Mailing Address - Country:US
Mailing Address - Phone:707-810-0098
Mailing Address - Fax:
Practice Address - Street 1:1726 SONOMA BLVD
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-6012
Practice Address - Country:US
Practice Address - Phone:707-810-0098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EARLY CHILDHOOD MENTAL HEALTH PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)