| Pacific Blue Psychological Services | |
|
15235 Burbank Blvd Ste A2 Sherman Oaks CA 91411-3555 | |
| (858) 883-3277 | |
| Not Available |
| Full Name | Pacific Blue Psychological Services |
|---|---|
| Speciality | Psychologist |
| Location | 15235 Burbank Blvd Ste A2, Sherman Oaks, California |
| Authorized Official Name and Position | John Carroll (OWNER) |
| Authorized Official Contact | 8588833277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Blue Psychological Services Po Box 1290 Venice CA 90294-1290 Ph: () - | Pacific Blue Psychological Services 15235 Burbank Blvd Ste A2 Sherman Oaks CA 91411-3555 Ph: (858) 883-3277 |
| NPI Number | 1124678719 |
|---|---|
| Provider Enumeration Date | 09/16/2019 |
| Last Update Date | 10/09/2020 |
| Certification Date | 10/09/2020 |
| Medicare PECOS PAC ID | 3678908357 |
|---|---|
| Medicare Enrollment ID | O20200129000198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124678719 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | John Joseph Carroll |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972002236 PECOS PAC ID: 5991067837 Enrollment ID: I20180313000982 |
| Provider Name | Shawdi Spencer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891183752 PECOS PAC ID: 0143562231 Enrollment ID: I20190418002400 |
| Provider Name | Ariel Fawn Ogilvie Mcsweeney |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669706586 PECOS PAC ID: 0244665792 Enrollment ID: I20200110002361 |
| Provider Name | Adam West |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538704457 PECOS PAC ID: 6204261472 Enrollment ID: I20200116000013 |
| Provider Name | Daniel Stephen Szuhay |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679899249 PECOS PAC ID: 5890198378 Enrollment ID: I20210721001236 |
| Provider Name | Shawna Hogan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467578773 PECOS PAC ID: 8820482771 Enrollment ID: I20220218001639 |
| Provider Name | Naomi Senft |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447993647 PECOS PAC ID: 6002293800 Enrollment ID: I20220517001980 |
| Provider Name | Michele Du Bow |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538438247 PECOS PAC ID: 5890169411 Enrollment ID: I20230322002981 |
| Provider Name | Mary Cherub Tagle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790011492 PECOS PAC ID: 4082088554 Enrollment ID: I20230323002216 |
| Provider Name | Jeffrey Hanna |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366144172 PECOS PAC ID: 0446624928 Enrollment ID: I20230323002818 |
| Provider Name | Mary Wilkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114311339 PECOS PAC ID: 6103290341 Enrollment ID: I20230329002824 |
| Provider Name | Minoo Dargah |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1962960864 PECOS PAC ID: 5890169031 Enrollment ID: I20230329003089 |
| Provider Name | Alexander Spencer Edwards |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629109269 PECOS PAC ID: 8123484979 Enrollment ID: I20230519002460 |
| Provider Name | Cynthia Talmich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376013227 PECOS PAC ID: 9234589532 Enrollment ID: I20231228003405 |
| Provider Name | Chris Gonzalez Herrera |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1831638857 PECOS PAC ID: 1355780560 Enrollment ID: I20240422001156 |
| Provider Name | Graciela Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467878793 PECOS PAC ID: 2365882446 Enrollment ID: I20240507000886 |
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