MEDICARE: DR. ANASTASIA ELAINA HARRELL PSY.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	103G00000X	Clinical Neuropsychologist	33553	CA
2	103TC0700X	Clinical Psychologist	33553	CA

General Provider Information

NPI Number	:	1629795695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANASTASIA ELAINA HARRELL PSY.D.

Provider Business Mailing Address
First Line	:	110 EL NIDO AVE APT 69
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-4489
Country	:	US
Telephone Number	:	805-358-0246
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 FAIR OAKS AVE STE 101
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-2685
Country	:	US
Telephone Number	:	626-765-4482
Fax Number	:

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

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	10/20/2022

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