Provider Demographics
NPI:1972141356
Name:DR. BRITTANY DAFESH, CLINICAL PSYCHOLOGIST INC.
Entity Type:Organization
Organization Name:DR. BRITTANY DAFESH, CLINICAL PSYCHOLOGIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:DAFESH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:714-504-1992
Mailing Address - Street 1:1611 S PACIFIC COAST HWY STE 307
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5614
Mailing Address - Country:US
Mailing Address - Phone:424-272-5950
Mailing Address - Fax:
Practice Address - Street 1:1611 S PACIFIC COAST HWY STE 307
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5614
Practice Address - Country:US
Practice Address - Phone:424-272-5950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty