MEDICARE: DIVERSITUS PSYCHOTHERAPY & PSYCHOANALYSIS INC

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

General Provider Information

NPI Number	:	1982578878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSITUS PSYCHOTHERAPY & PSYCHOANALYSIS INC

Provider Business Mailing Address
First Line	:	644 N SANTA CRUZ AVE STE 8
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95030-4353
Country	:	US
Telephone Number	:	650-924-7323
Fax Number	:

Provider Business Practice Location Address
First Line	:	644 N SANTA CRUZ AVE STE 8
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95030-4353
Country	:	US
Telephone Number	:	650-924-7323
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AYELET SCHAFIR-HIRSHFELD
Credential	:	PHD
Telephone Number	:	650-924-7323

Provider Enumeration Date	:	10/02/2025
Last Update Date	:	10/02/2025

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