Provider Demographics
NPI:1053598201
Name:THE NEUROBEHAVIORAL HEALTHCARE CENTER, A PROFESSIONAL PSYCHOLOGICAL CO
Entity type:Organization
Organization Name:THE NEUROBEHAVIORAL HEALTHCARE CENTER, A PROFESSIONAL PSYCHOLOGICAL CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-855-3288
Mailing Address - Street 1:326 S PACIFIC COAST HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3769
Mailing Address - Country:US
Mailing Address - Phone:310-855-3498
Mailing Address - Fax:310-855-3498
Practice Address - Street 1:326 S PACIFIC COAST HWY STE 200
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3769
Practice Address - Country:US
Practice Address - Phone:310-855-3288
Practice Address - Fax:310-855-3498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21258103G00000X, 103T00000X, 103TA0700X, 103TC0700X, 103TH0004X
CAPSY21769103G00000X, 103T00000X, 103TA0700X, 103TC0700X, 103TH0004X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP21258Medicare UPIN