Provider Demographics
NPI:1831655273
Name:SURANEE A WALESZONIA PH D A PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:SURANEE A WALESZONIA PH D A PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SURANEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALESZONIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-745-6850
Mailing Address - Street 1:246 SAINT CRISPEN AVE
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4000
Mailing Address - Country:US
Mailing Address - Phone:818-439-7033
Mailing Address - Fax:
Practice Address - Street 1:135 S STATE COLLEGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5805
Practice Address - Country:US
Practice Address - Phone:714-745-6850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty