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General NPI Number Information
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NPI Number | 1770968737
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Entity Type | Individual
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Provider Name | JENNIFER GEORGIAN LA GUARDIA PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 5276 HOLLISTER AVE SUITE 457
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City | GOLETA
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State | CA
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Zip | 93111-2073
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Country | US
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Telephone | 805-450-5271
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 815
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City | SANTA BARBARA
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State | CA
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Zip | 93102-0815
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Country | US
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Telephone | 805-450-5271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 27223
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 016109-1
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License Number State | NY
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