MEDICARE: DR. ROBERTA G WYMAN PH.D.

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
1	103TC0700X	Clinical Psychologist	PSY12487	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY12487	OTHER	CA	CALIF LIC

General Provider Information

NPI Number	:	1073738225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTA G WYMAN PH.D.

Provider Business Mailing Address
First Line	:	17011 BEACH BLVD
Second Line	:	SUITE 900
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5946
Country	:	US
Telephone Number	:	714-842-8680
Fax Number	:	714-375-6699

Provider Business Practice Location Address
First Line	:	16581 SELL CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-3298
Country	:	US
Telephone Number	:	714-842-8680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	03/22/2026

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