Provider Demographics
NPI:1437595543
Name:JOANNE BARGE, PHD. INC., A PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:JOANNE BARGE, PHD. INC., A PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BARGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-472-2329
Mailing Address - Street 1:12011 SAN VICENTE BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4947
Mailing Address - Country:US
Mailing Address - Phone:310-472-2329
Mailing Address - Fax:310-472-1399
Practice Address - Street 1:12011 SAN VICENTE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4947
Practice Address - Country:US
Practice Address - Phone:310-472-2329
Practice Address - Fax:310-472-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14116103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty