Provider Demographics
NPI:1215495551
Name:INTUITIVE PSYCHOTHERAPY ASSOCIATES, LICENSED CLINICAL SOCIAL WORKER PC
Entity type:Organization
Organization Name:INTUITIVE PSYCHOTHERAPY ASSOCIATES, LICENSED CLINICAL SOCIAL WORKER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:MAUCERI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-694-2434
Mailing Address - Street 1:22048 SHERMAN WAY STE 115
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1893
Mailing Address - Country:US
Mailing Address - Phone:646-694-2434
Mailing Address - Fax:818-350-2988
Practice Address - Street 1:22048 SHERMAN WAY STE 115
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1893
Practice Address - Country:US
Practice Address - Phone:646-694-2434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty