Basic Information
| Provider Information | |||||||||
| NPI: | 1730630591 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TARZANA TREATMENT CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13535 VALERIO ST APT 258 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914052723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186186097 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8330 RESEDA BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913244619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189961051 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2016 | ||||||||
| LastUpdateDate: | 10/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | RAGOSTA | ||||||||
| AuthorizedOfficialFirstName: | LORRAINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 8185431820 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LORRAINE RAGOSTA LMF | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
No ID Information.