Healthcare Provider Details

I. General information

NPI: 1295871663
Provider Name (Legal Business Name): PSYCHOLOGICAL TREATMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19543 MAYALL ST
NORTHRIDGE CA
91324-1015
US

IV. Provider business mailing address

19543 MAYALL ST
NORTHRIDGE CA
91324-1015
US

V. Phone/Fax

Practice location:
  • Phone: 818-718-9705
  • Fax: 818-718-2276
Mailing address:
  • Phone: 818-718-9705
  • Fax: 818-718-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES BRENT WASSERMAN
Title or Position: PRESIDENT PSYCHOLOGIST
Credential: PH.D.
Phone: 818-718-9705