Provider Demographics
NPI:1386100907
Name:NCADD-SFV
Entity type:Organization
Organization Name:NCADD-SFV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR OF CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARDER
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-II
Authorized Official - Phone:818-997-0414
Mailing Address - Street 1:6166 VESPER AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2851
Mailing Address - Country:US
Mailing Address - Phone:818-997-0414
Mailing Address - Fax:818-785-3641
Practice Address - Street 1:6166 VESPER AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2851
Practice Address - Country:US
Practice Address - Phone:818-997-0414
Practice Address - Fax:818-785-3641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02106211Medicaid