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General NPI Number Information
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NPI Number | 1447010053
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Entity Type | Organization
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Legal Business Name | IRENE S. FRUCHTBAUM, PH.D., Q.M.E.
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 28310 ROADSIDE DR STE 202A
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4958
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Country | US
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Telephone | 818-650-1960
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4117
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City | WEST HILLS
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State | CA
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Zip | 91308-4117
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Country | US
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Telephone | 310-699-6510
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. IRENE FRUCHTBAUM
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Credential | PH.D., Q.M.E.
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Telephone | 818-650-1960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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