Healthcare Provider Details

I. General information

NPI: 1477817559
Provider Name (Legal Business Name): CENTER FOR SOCIAL COGNITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 TECHNOLOGY DR SUITE 100
IRVINE CA
92618-2355
US

IV. Provider business mailing address

16 TECHNOLOGY DR SUITE 100
IRVINE CA
92618-2355
US

V. Phone/Fax

Practice location:
  • Phone: 949-788-9299
  • Fax: 949-453-8118
Mailing address:
  • Phone: 949-788-9299
  • Fax: 949-453-8118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-6782
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC28039
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 12699
License Number StateCA

VIII. Authorized Official

Name: DR. KARINA POIRIER
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: BCBA
Phone: 949-788-9299