Provider Demographics
NPI:1962061739
Name:ACACIA PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:ACACIA PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:
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 1:281 MAGNOLIA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-3608
Mailing Address - Country:US
Mailing Address - Phone:805-472-6099
Mailing Address - Fax:805-472-6099
Practice Address - Street 1:740 FRONT ST STE 220
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4536
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:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty