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General NPI Number Information
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NPI Number | 1588917520
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Entity Type | Organization
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Legal Business Name | PHOENIX PSYCHOLOGICAL GROUP, PC
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 1601 CARMEN DR SUITE 211
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City | CAMARILLO
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State | CA
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Zip | 93010-3105
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Country | US
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Telephone | 805-232-4148
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Fax |
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Provider Business Mailing Address
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Address Line | 35 W MAIN ST SUITE B-368
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City | VENTURA
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State | CA
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Zip | 93001-2507
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Country | US
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Telephone | 805-232-4148
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SUSAN CHRISTINE BARRETT
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Credential | PSYD
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Telephone | 805-637-9997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY21349
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License Number State | CA
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