MEDICARE: BRAIN POWER PSYCHOLOGY INC.

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
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1326788258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAIN POWER PSYCHOLOGY INC.

Provider Business Mailing Address
First Line	:	2444 WILSHIRE BLVD STE 202
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5810
Country	:	US
Telephone Number	:	336-458-7992
Fax Number	:

Provider Business Practice Location Address
First Line	:	2444 WILSHIRE BLVD STE 202
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5810
Country	:	US
Telephone Number	:	336-458-7992
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SOURENA HAJ-MOHAMADI
Credential	:	PH.D
Telephone Number	:	336-458-7992

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	03/30/2022

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