Provider Demographics
NPI:1497981054
Name:DEVELOPMENTAL GUIDANCE SERVICES INC.
Entity Type:Organization
Organization Name:DEVELOPMENTAL GUIDANCE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:F
Authorized Official - Last Name:NEWBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:562-537-9268
Mailing Address - Street 1:17150 NEWHOPE ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4250
Mailing Address - Country:US
Mailing Address - Phone:714-437-7400
Mailing Address - Fax:714-437-7410
Practice Address - Street 1:16560 HARBOR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1336
Practice Address - Country:US
Practice Address - Phone:714-437-7400
Practice Address - Fax:714-437-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4593103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP4593Medicare PIN