Healthcare Provider Details

I. General information

NPI: 1023486222
Provider Name (Legal Business Name): JAIMEE SILVERA HARTMAN PSY.D., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 S. WILMINGTON AVE. BLDG. 18, SUITE 300
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

12021 S. WILMINGTON AVE. BLDG. 18, SUITE 300
LOS ANGELES CA
90059-3019
US

V. Phone/Fax

Practice location:
  • Phone: 213-842-2577
  • Fax: 213-477-2159
Mailing address:
  • Phone: 213-842-2577
  • Fax: 213-477-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32709
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number85368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: