Provider Demographics
NPI:1487063483
Name:SOCIAL-EMOTIONAL & EDUCATION DEVELOPMENT SERVICES
Entity type:Organization
Organization Name:SOCIAL-EMOTIONAL & EDUCATION DEVELOPMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:JANELLE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:562-682-7697
Mailing Address - Street 1:17807 CANTARA ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1516
Mailing Address - Country:US
Mailing Address - Phone:818-527-2230
Mailing Address - Fax:818-322-1334
Practice Address - Street 1:17807 CANTARA ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1516
Practice Address - Country:US
Practice Address - Phone:818-527-2230
Practice Address - Fax:818-322-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1107000103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty