MEDICARE: CENTER FOR COGNITION AND COMPASSION: PSYCHOLOGICAL CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106H00000X	Marriage & Family Therapist
2	106S00000X	Behavior Technician
3	106E00000X	Assistant Behavior Analyst
4	101Y00000X	Counselor
5	101YA0400X	Addiction (Substance Use Disorder) Counselor
6	103G00000X	Clinical Neuropsychologist
7	103K00000X	Behavior Analyst
8	103TF0200X	Forensic Psychologist
9	103TR0400X	Rehabilitation Psychologist
10	104100000X	Social Worker
11	103T00000X	Psychologist

General Provider Information

NPI Number	:	1235845090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR COGNITION AND COMPASSION: PSYCHOLOGICAL CORPORATION

Provider Business Mailing Address
First Line	:	901 H ST STE 120-107
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-1805
Country	:	US
Telephone Number	:	323-205-5352
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 H ST STE 120-107
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-1805
Country	:	US
Telephone Number	:	323-205-5352
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. AMIR RAMEZANI
Credential	:	PHD
Telephone Number	:	323-205-5352

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	01/25/2023

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