MEDICARE: JOANNE BARGE, PHD. INC., A PSYCHOLOGY CORPORATION

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	103T00000X	Psychologist	PSY14116	CA

General Provider Information

NPI Number	:	1437595543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNE BARGE, PHD. INC., A PSYCHOLOGY CORPORATION

Provider Business Mailing Address
First Line	:	12011 SAN VICENTE BLVD STE 510
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4947
Country	:	US
Telephone Number	:	310-472-2329
Fax Number	:	310-472-1399

Provider Business Practice Location Address
First Line	:	12011 SAN VICENTE BLVD STE 510
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4947
Country	:	US
Telephone Number	:	310-472-2329
Fax Number	:	310-472-1399

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOANNE P BARGE
Credential	:	PH.D.
Telephone Number	:	310-472-2329

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	05/15/2013

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