Provider Demographics
NPI:1861542375
Name:CATHOLIC CHARITIES PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:CATHOLIC CHARITIES PSYCHOLOGICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SR. ROSEANITA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-622-2824
Mailing Address - Street 1:1215 S HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2850
Mailing Address - Country:US
Mailing Address - Phone:909-622-2824
Mailing Address - Fax:909-622-6984
Practice Address - Street 1:1215 S HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2850
Practice Address - Country:US
Practice Address - Phone:909-622-2824
Practice Address - Fax:909-622-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34250106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty