| Depth Psychotherapy Center A Professional Psychological Corpora | |
|
4199 Campus Dr. Suite 550 Irvine CA 92612 | |
| (949) 422-4488 | |
| (949) 640-2255 |
| Full Name | Depth Psychotherapy Center A Professional Psychological Corpora |
|---|---|
| Speciality | Psychologist |
| Location | 4199 Campus Dr., Irvine, California |
| Authorized Official Name and Position | Sherri Mahdavi (OWNER) |
| Authorized Official Contact | 9494224488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Depth Psychotherapy Center A Professional Psychological Corpora 750 Terrado Plz Suite 40 Covina CA 91723 Ph: (626) 332-0556 | Depth Psychotherapy Center A Professional Psychological Corpora 4199 Campus Dr. Suite 550 Irvine CA 92612 Ph: (949) 422-4488 |
| NPI Number | 1154638450 |
|---|---|
| Provider Enumeration Date | 09/08/2010 |
| Last Update Date | 07/01/2020 |
| Certification Date | 07/01/2020 |
| Medicare PECOS PAC ID | 9931378684 |
|---|---|
| Medicare Enrollment ID | O20110815000176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154638450 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY21506 (California) | Primary |
| Provider Name | Sherri Mahdavi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356575567 PECOS PAC ID: 4385785955 Enrollment ID: I20100104000652 |
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