MEDICARE: DR. STEVEN J. HENDLIN 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	103T00000X	Psychologist	PSY 5019	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33-0138485	OTHER		FED. TAX ID

General Provider Information

NPI Number	:	1770677387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN J. HENDLIN PH.D.

Provider Business Mailing Address
First Line	:	230 NEWPORT CENTER DR.
Second Line	:	#220
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7533
Country	:	US
Telephone Number	:	949-644-7707
Fax Number	:	949-720-0940

Provider Business Practice Location Address
First Line	:	230 NEWPORT CENTER DR.
Second Line	:	#220
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7533
Country	:	US
Telephone Number	:	949-644-7707
Fax Number	:	949-720-0940

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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