| Jaime Elizabeth Medvene Phd A Professional Psychological Corpora | |
|
30200 Agoura Rd Suite 190 Agoura Hills CA 91301-5434 | |
| (818) 981-7845 | |
| Not Available |
| Full Name | Jaime Elizabeth Medvene Phd A Professional Psychological Corpora |
|---|---|
| Speciality | Psychologist |
| Location | 30200 Agoura Rd, Agoura Hills, California |
| Authorized Official Name and Position | Jaime Elizabeth Medvene (PRESIDENT) |
| Authorized Official Contact | 8189817845 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jaime Elizabeth Medvene Phd A Professional Psychological Corpora 30200 Agoura Rd Suite 190 Agoura Hills CA 91301-5434 Ph: (818) 981-7845 | Jaime Elizabeth Medvene Phd A Professional Psychological Corpora 30200 Agoura Rd Suite 190 Agoura Hills CA 91301-5434 Ph: (818) 981-7845 |
| NPI Number | 1306084272 |
|---|---|
| Provider Enumeration Date | 01/30/2009 |
| Last Update Date | 05/15/2020 |
| Certification Date | 05/15/2020 |
| Medicare PECOS PAC ID | 7911063201 |
|---|---|
| Medicare Enrollment ID | O20090312000135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306084272 | NPI | - | NPPES |
| PSY137401 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | CP13740 (California) | Primary |
| Provider Name | Charles B Wasserman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659361731 PECOS PAC ID: 5698765485 Enrollment ID: I20040513001445 |
| Provider Name | Luz E Vulgaris |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215133020 PECOS PAC ID: 7618916628 Enrollment ID: I20050428001116 |
| Provider Name | Jaime Elizabeth Medvene |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1265478754 PECOS PAC ID: 1759303134 Enrollment ID: I20051228000797 |
| Provider Name | Deborah M Kenigsberg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487929857 PECOS PAC ID: 9830484591 Enrollment ID: I20160821000000 |
| Provider Name | Tameeza Samji |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578663613 PECOS PAC ID: 9739435538 Enrollment ID: I20180710001014 |
| Provider Name | Christopher Gene Watson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982052635 PECOS PAC ID: 6507257565 Enrollment ID: I20211229002231 |
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