| Elderly Behavioral Wellness Services Inc | |
|
2001 S Barrington Ave Ste 314 Los Angeles CA 90025-5379 | |
| (310) 999-9683 | |
| Not Available |
| Full Name | Elderly Behavioral Wellness Services Inc |
|---|---|
| Speciality | Psychologist |
| Location | 2001 S Barrington Ave Ste 314, Los Angeles, California |
| Authorized Official Name and Position | Eleni Bagourdi (CEO) |
| Authorized Official Contact | 3109999683 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elderly Behavioral Wellness Services Inc 2001 S Barrington Ave Ste 314 Los Angeles CA 90025-5379 Ph: () - | Elderly Behavioral Wellness Services Inc 2001 S Barrington Ave Ste 314 Los Angeles CA 90025-5379 Ph: (310) 999-9683 |
| NPI Number | 1871983106 |
|---|---|
| Provider Enumeration Date | 01/26/2015 |
| Last Update Date | 06/01/2021 |
| Certification Date | 06/01/2021 |
| Medicare PECOS PAC ID | 4082934880 |
|---|---|
| Medicare Enrollment ID | O20150519001108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871983106 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0700X | Psychologist - Adult Development & Aging | PSY22542 (California) | Primary |
| Provider Name | Emi Iijima |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1154551760 PECOS PAC ID: 1456583152 Enrollment ID: I20140411000690 |
| Provider Name | Melissa Stolsig |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881912301 PECOS PAC ID: 1153663026 Enrollment ID: I20190424001012 |
| Provider Name | Eleni Bagourdi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447490958 PECOS PAC ID: 9335297365 Enrollment ID: I20191219002611 |
| Provider Name | Antonia Marie Hickey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255619656 PECOS PAC ID: 3375970403 Enrollment ID: I20200302000170 |
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