Healthcare Provider Details

I. General information

NPI: 1508780594
Provider Name (Legal Business Name): VANDER DUSSEN & ASSOCIATES PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S KRAEMER BLVD STE 114
PLACENTIA CA
92870-6109
US

IV. Provider business mailing address

101 S KRAEMER BLVD STE 114
PLACENTIA CA
92870-6109
US

V. Phone/Fax

Practice location:
  • Phone: 714-329-6080
  • Fax:
Mailing address:
  • Phone: 714-329-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY VANDER DUSSEN
Title or Position: OWNER
Credential: PSY.D.
Phone: 714-329-6080