Provider Demographics
NPI:1790812147
Name:ARBORVIEW PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:ARBORVIEW PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARICHU
Authorized Official - Middle Name:CARRION
Authorized Official - Last Name:WOLMERATH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-841-1330
Mailing Address - Street 1:PO BOX 10313
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685
Mailing Address - Country:US
Mailing Address - Phone:714-841-1330
Mailing Address - Fax:714-841-1316
Practice Address - Street 1:16152 BEACH BLVD SUITE 179
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647
Practice Address - Country:US
Practice Address - Phone:714-841-1330
Practice Address - Fax:714-841-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16356103T00000X
CAMFC20709106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP16356Medicare ID - Type Unspecified