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General NPI Number Information
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NPI Number | 1487473575
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Entity Type | Organization
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Legal Business Name | OC NEUROPSYCH, A PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 16405 SAND CANYON AVE STE 220
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City | IRVINE
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State | CA
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Zip | 92618-3787
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Country | US
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Telephone | 949-336-8150
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Fax |
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Provider Business Mailing Address
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Address Line | 16405 SAND CANYON AVE STE 220
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City | IRVINE
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State | CA
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Zip | 92618-3787
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Country | US
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Telephone | 949-336-8150
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAUREN BENNETT
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Credential | PHD
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Telephone | 949-291-2736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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