Healthcare Provider Details

I. General information

NPI: 1053598201
Provider Name (Legal Business Name): THE NEUROBEHAVIORAL HEALTHCARE CENTER, A PROFESSIONAL PSYCHOLOGICAL CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S PACIFIC COAST HWY STE 200
REDONDO BEACH CA
90277-3769
US

IV. Provider business mailing address

326 S PACIFIC COAST HWY STE 200
REDONDO BEACH CA
90277-3769
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-3288
  • Fax: 310-855-3498
Mailing address:
  • Phone: 310-855-3498
  • Fax: 310-855-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY21769
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21258
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21769
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY21258
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY21769
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21258
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21769
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY21258
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY21769
License Number StateCA
# 11
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY21258
License Number StateCA

VIII. Authorized Official

Name: RAPHAEL ZIEGLER
Title or Position: PRESIDENT
Credential:
Phone: 310-855-3288