| Spencer Scott Psychologist Corp | |
|
2510 Main St Ste 201 Santa Monica CA 90405-3581 | |
| (323) 999-1395 | |
| Not Available |
| Full Name | Spencer Scott Psychologist Corp |
|---|---|
| Speciality | Psychologist |
| Location | 2510 Main St Ste 201, Santa Monica, California |
| Authorized Official Name and Position | William Spencer Scott (SOLE OWNER) |
| Authorized Official Contact | 3239991395 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spencer Scott Psychologist Corp 2500 Bennett Ave 1405 Dallas TX 75206-7171 Ph: () - | Spencer Scott Psychologist Corp 2510 Main St Ste 201 Santa Monica CA 90405-3581 Ph: (323) 999-1395 |
| NPI Number | 1194249292 |
|---|---|
| Provider Enumeration Date | 07/31/2017 |
| Last Update Date | 09/28/2017 |
| Medicare PECOS PAC ID | 9931468089 |
|---|---|
| Medicare Enrollment ID | O20180117001613 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194249292 | NPI | - | NPPES |
| 1124548359 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Cesar G Ureta |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356498992 PECOS PAC ID: 9133161359 Enrollment ID: I20050527000470 |
| Provider Name | Ann Y Gottuso |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407224512 PECOS PAC ID: 1153621636 Enrollment ID: I20151207000822 |
| Provider Name | Mary-jo L Bautista |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003166380 PECOS PAC ID: 6507140357 Enrollment ID: I20170223000722 |
| Provider Name | William S Scott |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124548359 PECOS PAC ID: 9234401225 Enrollment ID: I20170825002390 |
| Provider Name | Tameeza Samji |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578663613 PECOS PAC ID: 9739435538 Enrollment ID: I20180710001014 |
| Provider Name | Yasaman Shamtoub |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568697852 PECOS PAC ID: 0941540173 Enrollment ID: I20190325002397 |
| Provider Name | Elisa Leal |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992364905 PECOS PAC ID: 4587992136 Enrollment ID: I20190821001604 |
| Provider Name | Mackenzie Lambine |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063061240 PECOS PAC ID: 7214369255 Enrollment ID: I20191113002658 |
| Provider Name | Rebecca Lecroix |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508441312 PECOS PAC ID: 7618384736 Enrollment ID: I20210407001361 |
| Provider Name | Jamie Gamboa |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598242141 PECOS PAC ID: 7911397294 Enrollment ID: I20211130001864 |
| Provider Name | Susan Chi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548912942 PECOS PAC ID: 9436543055 Enrollment ID: I20220224002790 |
| Provider Name | Taylor Dovala |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1962931006 PECOS PAC ID: 1658749569 Enrollment ID: I20221128001640 |
| Provider Name | Catherine Teotico |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659982825 PECOS PAC ID: 5294109310 Enrollment ID: I20230313001008 |
| Provider Name | Janice Castro |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942726062 PECOS PAC ID: 5698130359 Enrollment ID: I20230502001712 |
| Provider Name | Derik A Hossepian |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477163004 PECOS PAC ID: 2062867583 Enrollment ID: I20231018001155 |
| Provider Name | Azeen Nafisi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235625211 PECOS PAC ID: 6204281751 Enrollment ID: I20231018002349 |
| Provider Name | Maya Florsheim |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629596564 PECOS PAC ID: 9436504917 Enrollment ID: I20231018004084 |
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