Provider Demographics
NPI:1578510004
Name:TAUBENFELD PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:TAUBENFELD PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAUBENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-529-8293
Mailing Address - Street 1:200 N MARYLAND AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4262
Mailing Address - Country:US
Mailing Address - Phone:818-243-0903
Mailing Address - Fax:818-243-0905
Practice Address - Street 1:200 N MARYLAND AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4262
Practice Address - Country:US
Practice Address - Phone:818-243-0903
Practice Address - Fax:818-243-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18267103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18946Medicare Oscar/Certification