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NPI Code Detail

MEDICARE: ANDREA L JAMISON PH.D.

MEDICARE: ANDREA L JAMISON PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist0810009053VA
2103TC0700XClinical PsychologistPSY24836CA

General Provider Information

NPI Number : 1134586548
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA L JAMISON PH.D.
Provider Business Mailing Address
First Line : 5665 WILSHIRE BLVD # 1164
Second Line :
City : LOS ANGELES
State : CA
Zip : 90036-3710
Country : US
Telephone Number : 424-209-2029
Fax Number :
Provider Business Practice Location Address
First Line : 14321 WINTER BREEZE DR STE 198
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23113-2452
Country : US
Telephone Number : 424-209-2029
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2016
Last Update Date : 01/04/2026

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