MEDICARE: DR. MARGARET ANN HENDRICKS 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
1	103TC0700X	Clinical Psychologist	PSY13204	CA

General Provider Information

NPI Number	:	1386862258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGARET ANN HENDRICKS PH.D.

Provider Business Mailing Address
First Line	:	4336 ROUSSEAU LN
Second Line	:
City	:	PALOS VERDES PENINSULA
State	:	CA
Zip	:	90274-3954
Country	:	US
Telephone Number	:	310-544-8112
Fax Number	:

Provider Business Practice Location Address
First Line	:	4336 ROUSSEAU LN
Second Line	:
City	:	PALOS VERDES PENINSULA
State	:	CA
Zip	:	90274-3954
Country	:	US
Telephone Number	:	310-544-8112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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