Provider Demographics
NPI:1285144691
Name:NEW LIFE FAMILY COUNSELING, A PROFESIONAL CLINICAL SOCIAL WORKER CORP.
Entity type:Organization
Organization Name:NEW LIFE FAMILY COUNSELING, A PROFESIONAL CLINICAL SOCIAL WORKER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:626-353-8772
Mailing Address - Street 1:5606 WELLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2933
Mailing Address - Country:US
Mailing Address - Phone:626-353-8772
Mailing Address - Fax:800-806-3121
Practice Address - Street 1:440 E HUNTINGTON DR STE 360
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3776
Practice Address - Country:US
Practice Address - Phone:626-353-8772
Practice Address - Fax:800-806-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA775211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992881312OtherCOMMERCIAL