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NPI Code Detail

MEDICARE: JAMIE LEIGH NIERENBERG PSYD

MEDICARE: JAMIE LEIGH NIERENBERG PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist
2390200000XStudent in an Organized Health Care Education/Training Program
3103TC0700XClinical PsychologistPSY35103CA
4103T00000XPsychologistPSY35103CA

General Provider Information

NPI Number : 1063840031
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE LEIGH NIERENBERG PSYD
Provider Business Mailing Address
First Line : 1891 EFFIE ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-1793
Country : US
Telephone Number : 323-644-2000
Fax Number :
Provider Business Practice Location Address
First Line : 1891 EFFIE ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-1793
Country : US
Telephone Number : 323-644-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2013
Last Update Date : 08/01/2024

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