Provider Demographics
NPI:1487473575
Name:OC NEUROPSYCH, A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:OC NEUROPSYCH, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-291-2736
Mailing Address - Street 1:16405 SAND CANYON AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3787
Mailing Address - Country:US
Mailing Address - Phone:949-336-8150
Mailing Address - Fax:
Practice Address - Street 1:16405 SAND CANYON AVE STE 220
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3787
Practice Address - Country:US
Practice Address - Phone:949-336-8150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty