Healthcare Provider Details

I. General information

NPI: 1780709089
Provider Name (Legal Business Name): JAIMIE SCHWEITZER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5606 OSTROM AVE
ENCINO CA
91316-1404
US

IV. Provider business mailing address

5606 OSTROM AVE
ENCINO CA
91316-1404
US

V. Phone/Fax

Practice location:
  • Phone: 818-906-1103
  • Fax: 818-789-8688
Mailing address:
  • Phone: 818-906-1103
  • Fax: 818-789-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15552
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY15552
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15552
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY15552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: