Individual provider Active NPI

Indhushree S. Rajan, PH.D.

  • Clinical Psychologist
  • Beverly Hills, CA
National Provider Identifier
1205084027
Registry record updated Jan 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY30808 Issued in CA
Practice address
433 N Camden Dr FL 4
Beverly Hills, CA 90210-4408
Phone
(424) 285-3547
NPI assigned
Sep 4, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY30808 CA Primary

Addresses

Primary practice location

433 N Camden Dr FL 4
Beverly Hills, CA 90210-4408

Mailing address

5132 Maplewood Ave Apt 103
Los Angeles, CA 90004-1583
Phone (714) 402-8101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200309001046 CA Practitioner - Clinical Psychologist 0840628715

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

5132 Maplewood Ave
Apt 103
Los Angeles, CA 90004-1583

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY30808CAMDClinical Psychologist
30808CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Conscious Lyfe Psychological Services Inc. Clinical CurrentSince Dec 18, 2020 Accepting new patients

Locations

433 N Camden Dr
Fl 4
Beverly Hills, CA 90210
Phone (310) 360-0080

468 N Camden Dr
Ste 200
Beverly Hills, CA 90210
Phone (213) 235-9675

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1205084027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5132 MAPLEWOOD AVE APT 103",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900041583",
            "telephone_number": "714-402-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 N CAMDEN DR FL 4",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902104408",
            "telephone_number": "424-285-3547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJAN",
        "first_name": "INDHUSHREE",
        "middle_name": "S.",
        "name_prefix": "Miss",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-04",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY30808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

Verify at the official NPI Registry.