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General NPI Number Information
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NPI Number | 1942179676
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Entity Type | Organization
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Legal Business Name | METAMORPHOSIS PSYCHOLOGY SERVICES PC
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Dates
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Enumeration Date | 10/31/2025
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 26812 VIA LLANO
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City | MISSION VIEJO
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State | CA
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Zip | 92691
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Country | US
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Telephone | 718-902-6947
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 N VIRGIL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90029-2016
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Country | US
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Telephone | 718-902-6947
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURA KOHBERGER-RAFEI
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Credential | PH.D.
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Telephone | 718-902-6947
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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 |
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License Number State |
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