Provider Demographics
NPI:1386139087
Name:ACACIA PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:ACACIA PSYCHOLOGICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-472-6099
Mailing Address - Street 1:948 EMBARCADERO DEL NORTE STE 102
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-5106
Mailing Address - Country:US
Mailing Address - Phone:805-472-6099
Mailing Address - Fax:
Practice Address - Street 1:1019 GAYLEY AVE FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3437
Practice Address - Country:US
Practice Address - Phone:888-699-4873
Practice Address - Fax:805-472-6099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACACIA PSYCHOLOGICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty