Healthcare Provider Details

I. General information

NPI: 1306670203
Provider Name (Legal Business Name): OCD, ANXIETY, AND TRAUMA PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 09/02/2024
Certification Date: 09/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 HIGHLAND AVE
BANGOR ME
04401-4652
US

IV. Provider business mailing address

1968 S COAST HWY # 1171
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 949-689-3229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NOELLE DECKMAN
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 949-689-3229