| Coastal Psychological Services, Inc. | |
|
1400 Quail St Ste 136 Newport Beach CA 92660-2788 | |
| (949) 385-2775 | |
| (949) 336-3763 |
| Full Name | Coastal Psychological Services, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 1400 Quail St Ste 136, Newport Beach, California |
| Authorized Official Name and Position | Jennifer Leath (PRESIDENT) |
| Authorized Official Contact | 9493852775 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Psychological Services, Inc. 1400 Quail St Ste 136 Newport Beach CA 92660-2788 Ph: (949) 385-2775 | Coastal Psychological Services, Inc. 1400 Quail St Ste 136 Newport Beach CA 92660-2788 Ph: (949) 385-2775 |
| NPI Number | 1588161384 |
|---|---|
| Provider Enumeration Date | 04/09/2018 |
| Last Update Date | 05/31/2024 |
| Certification Date | 05/31/2024 |
| Medicare PECOS PAC ID | 2769747179 |
|---|---|
| Medicare Enrollment ID | O20180605001578 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588161384 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY26109 (California) | Primary |
| Provider Name | Jennifer Leath |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497953442 PECOS PAC ID: 3779714852 Enrollment ID: I20140626000113 |
| Provider Name | Jason Arkin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013200583 PECOS PAC ID: 8123342359 Enrollment ID: I20150117000166 |
| Provider Name | Veronica Marie Montes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609135813 PECOS PAC ID: 8022384981 Enrollment ID: I20171019002414 |
| Provider Name | Lauren-rachelle Palazuelos |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689802167 PECOS PAC ID: 8628338332 Enrollment ID: I20180126002236 |
| Provider Name | Michelle R Palmer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639365018 PECOS PAC ID: 8022364348 Enrollment ID: I20180628002370 |
| Provider Name | Carlos Xavier Montano |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1619055720 PECOS PAC ID: 6507909371 Enrollment ID: I20190323000080 |
| Provider Name | Nina Tilka |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730716564 PECOS PAC ID: 3779913371 Enrollment ID: I20200422002689 |
| Provider Name | Maryam Boroujerdi-rad |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891986329 PECOS PAC ID: 3678838083 Enrollment ID: I20220603002030 |
| Provider Name | David Di Sano |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1992181440 PECOS PAC ID: 0042659252 Enrollment ID: I20240422000928 |
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