Healthcare Provider Details

I. General information

NPI: 1770498966
Provider Name (Legal Business Name): NEW WAVE PSYCHOLOGY CLINIC P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 BROADWAY STE 314C
BOULDER CO
80302-5233
US

IV. Provider business mailing address

1913 WESTBOURNE DR
OVIEDO FL
32765-5108
US

V. Phone/Fax

Practice location:
  • Phone: 949-229-2783
  • Fax:
Mailing address:
  • Phone: 949-229-2783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDMUND LABARBARA
Title or Position: OWNER AND CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 949-229-2783