Healthcare Provider Details

I. General information

NPI: 1437841814
Provider Name (Legal Business Name): HEIMBERG NEUROPSYCHOLOGY - PSYCHOLOGICAL TESTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 PARKWAY CALABASAS STE 218
CALABASAS CA
91302-3909
US

IV. Provider business mailing address

21300 DUMETZ RD APT G
WOODLAND HILLS CA
91364-4409
US

V. Phone/Fax

Practice location:
  • Phone: 424-234-1155
  • Fax: 855-943-3312
Mailing address:
  • Phone: 646-687-1004
  • Fax: 855-943-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON FREIBERG HEIMBERG
Title or Position: CEO
Credential: PSYD
Phone: 646-687-1004