Provider Demographics
NPI:1497038905
Name:SYNERGISTIC PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:SYNERGISTIC PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:714-734-4244
Mailing Address - Street 1:17401 IRVINE BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3038
Mailing Address - Country:US
Mailing Address - Phone:714-734-4244
Mailing Address - Fax:714-983-2333
Practice Address - Street 1:17401 IRVINE BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3038
Practice Address - Country:US
Practice Address - Phone:714-734-4244
Practice Address - Fax:714-983-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24393103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFH483AOtherMEDICARE PTAN