Provider Demographics
NPI:1922744101
Name:DERGREGORIAN PSYCHOLOGICAL, APC
Entity Type:Organization
Organization Name:DERGREGORIAN PSYCHOLOGICAL, APC
Other - Org Name:PORTER PSYCHOLOGICAL, APC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DERGREGORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA PSYD
Authorized Official - Phone:714-328-6307
Mailing Address - Street 1:231 E BURBANK BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1044
Mailing Address - Country:US
Mailing Address - Phone:626-460-0327
Mailing Address - Fax:
Practice Address - Street 1:231 E BURBANK BLVD APT 102
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1044
Practice Address - Country:US
Practice Address - Phone:626-460-0327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty