Provider Demographics
NPI:1992181143
Name:INGA SIMONIAN, PHD PSYCHOLOGY GROUP, INC.
Entity Type:Organization
Organization Name:INGA SIMONIAN, PHD PSYCHOLOGY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:INGA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-570-1636
Mailing Address - Street 1:14930 VENTURA BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14930 VENTURA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3487
Practice Address - Country:US
Practice Address - Phone:818-570-1636
Practice Address - Fax:818-698-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25302305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization