Provider Demographics
NPI:1194080846
Name:SPECIAL KIDS CRUSADE
Entity type:Organization
Organization Name:SPECIAL KIDS CRUSADE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKEY STURM
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:831-372-2730
Mailing Address - Street 1:1900 GARDEN RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5373
Mailing Address - Country:US
Mailing Address - Phone:831-372-2730
Mailing Address - Fax:831-372-5730
Practice Address - Street 1:1900 GARDEN RD
Practice Address - Street 2:SUITE 230
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5373
Practice Address - Country:US
Practice Address - Phone:831-372-2730
Practice Address - Fax:831-372-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041652251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health