Provider Demographics
NPI:1528251691
Name:GAY AND LESBIAN ADOLESCENT SOCIAL SERVICES AGENCY, INC.
Entity type:Organization
Organization Name:GAY AND LESBIAN ADOLESCENT SOCIAL SERVICES AGENCY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DECRESCENZO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-358-8727
Mailing Address - Street 1:650 N ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5022
Mailing Address - Country:US
Mailing Address - Phone:310-358-8727
Mailing Address - Fax:310-358-8721
Practice Address - Street 1:112 HAMILTON PL
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3809
Practice Address - Country:US
Practice Address - Phone:510-452-5437
Practice Address - Fax:510-452-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health