Healthcare Provider Details

I. General information

NPI: 1740635960
Provider Name (Legal Business Name): CATHERINE JAYNE FREDERICK PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE JAYNE HERRMANN

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 BLOOMFIELD AVE
NORWALK CA
90650-2015
US

IV. Provider business mailing address

11401 BLOOMFIELD AVE
NORWALK CA
90650-2015
US

V. Phone/Fax

Practice location:
  • Phone: 562-863-7011
  • Fax: 562-864-4560
Mailing address:
  • Phone: 562-863-7011
  • Fax: 562-864-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2695
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: