Healthcare Provider Details

I. General information

NPI: 1003723271
Provider Name (Legal Business Name): SENIOR NEUROPSYCHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23046 AVENIDA DE LA CARLOTA STE 600
LAGUNA HILLS CA
92653-1537
US

IV. Provider business mailing address

23046 AVENIDA DE LA CARLOTA STE 600
LAGUNA HILLS CA
92653-1537
US

V. Phone/Fax

Practice location:
  • Phone: 949-517-8342
  • Fax: 949-739-3247
Mailing address:
  • Phone: 949-517-8342
  • Fax: 949-739-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER MITOLO
Title or Position: PRESIDENT/PSYCHOLOGIST
Credential: PSYD
Phone: 949-517-8342