| My Concierge Psychotherapy Inc | |
|
24520 Hawthorne Blvd Ste 208 Torrance CA 90505-6843 | |
| (310) 985-5846 | |
| Not Available |
| Full Name | My Concierge Psychotherapy Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 24520 Hawthorne Blvd Ste 208, Torrance, California |
| Authorized Official Name and Position | Shabnam Sasha Kassai (OWNER) |
| Authorized Official Contact | 3109855846 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| My Concierge Psychotherapy Inc 24520 Hawthorne Blvd Ste 208 Torrance CA 90505-6843 Ph: (310) 985-5846 | My Concierge Psychotherapy Inc 24520 Hawthorne Blvd Ste 208 Torrance CA 90505-6843 Ph: (310) 985-5846 |
| NPI Number | 1740978394 |
|---|---|
| Provider Enumeration Date | 05/01/2023 |
| Last Update Date | 05/10/2023 |
| Certification Date | 05/10/2023 |
| Medicare PECOS PAC ID | 6103271044 |
|---|---|
| Medicare Enrollment ID | O20231012000332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740978394 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Candice Diane Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992956379 PECOS PAC ID: 0345605176 Enrollment ID: I20230501002772 |
| Provider Name | Shabnam Sasha Kassai |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457887895 PECOS PAC ID: 0648625582 Enrollment ID: I20231031000372 |
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