Provider Demographics
NPI:1801421599
Name:VANDERBURG PSYCHOLOGICAL, INC.
Entity type:Organization
Organization Name:VANDERBURG PSYCHOLOGICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERBURG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:562-572-5964
Mailing Address - Street 1:3551 FLORISTA ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2488
Mailing Address - Country:US
Mailing Address - Phone:562-489-7981
Mailing Address - Fax:
Practice Address - Street 1:3551 FLORISTA ST STE 1D
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2488
Practice Address - Country:US
Practice Address - Phone:562-489-7981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty