| Irene S. Fruchtbaum, Ph.d., Q.m.e. | |
|
28310 Roadside Dr Ste 202a Agoura Hills CA 91301-4958 | |
| (818) 650-1960 | |
| Not Available |
| Full Name | Irene S. Fruchtbaum, Ph.d., Q.m.e. |
|---|---|
| Speciality | Psychologist - Group Psychotherapy |
| Location | 28310 Roadside Dr Ste 202a, Agoura Hills, California |
| Authorized Official Name and Position | Irene Fruchtbaum (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8186501960 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Irene S. Fruchtbaum, Ph.d., Q.m.e. Po Box 4117 West Hills CA 91308-4117 Ph: (310) 699-6510 | Irene S. Fruchtbaum, Ph.d., Q.m.e. 28310 Roadside Dr Ste 202a Agoura Hills CA 91301-4958 Ph: (818) 650-1960 |
| NPI Number | 1447010053 |
|---|---|
| Provider Enumeration Date | 03/20/2024 |
| Last Update Date | 03/20/2024 |
| Certification Date | 03/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447010053 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP2701X | Psychologist - Group Psychotherapy | (* (Not Available)) | Primary |
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