Depth Psychotherapy Center a Professional Psychological Corpora

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY21506 Issued in CA

Legal business name

DEPTH PSYCHOTHERAPY CENTER A PROFESSIONAL PSYCHOLOGICAL CORPORA

Practice address

4199 Campus Dr.
Suite 550
Irvine, CA 92612

Phone

(949) 422-4488

Fax

(949) 640-2255

NPI assigned

Sep 8, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sherri Mahdavi, PHDNPI 1356575567

Title

Owner

Phone

(949) 422-4488

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sherri Mahdavi, PH.D

  • Clinical Psychologist
  • Irvine, CA
  • NPI 1356575567
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593561600000",
    "number": "1154638450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 TERRADO PLZ",
            "address_2": "SUITE 40",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "91723",
            "telephone_number": "626-332-0556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4199 CAMPUS DR.",
            "address_2": "SUITE 550",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "92612",
            "telephone_number": "949-422-4488",
            "fax_number": "949-640-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPTH PSYCHOTHERAPY CENTER A PROFESSIONAL PSYCHOLOGICAL CORPORA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-08",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A",
        "authorized_official_last_name": "MAHDAVI",
        "authorized_official_first_name": "SHERRI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-422-4488",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY21506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Sleep Care Alliance LLC
• Dentireal, Inc.
• Kim CHI Nang Deo, LCSW
• Aina Pearl Deocampo
• Depression Remedy Orange County TMS
• Melissa Deragisch, MA
• Sandra Derby
• Scott A Derkum, MD
• Dermatology and Laser Group of Irvine, a Medical Corporation
• Davoud Derogar

• Clinical Psychologist in Irvine, CA
• Providers in Irvine, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.