Healthcare Provider Details

I. General information

NPI: 1407304090
Provider Name (Legal Business Name): ERIN WAITE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 01/31/2021
Certification Date: 01/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 W CARSON ST B-4 SOUTH
TORRANCE CA
90502-2006
US

IV. Provider business mailing address

PO BOX 3218
CAMARILLO CA
93011-3218
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-7958
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY30554
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY30554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: