Provider Demographics
NPI:1740973791
Name:PSYCHOLOGY TASK FORCE CORP
Entity type:Organization
Organization Name:PSYCHOLOGY TASK FORCE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DE ANDA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:619-754-1928
Mailing Address - Street 1:136 N CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1805
Mailing Address - Country:US
Mailing Address - Phone:619-754-1928
Mailing Address - Fax:
Practice Address - Street 1:3928 COLEMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154
Practice Address - Country:US
Practice Address - Phone:619-754-1928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty