Neuroedge Psychological Services, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

NEUROEDGE PSYCHOLOGICAL SERVICES, INC.

Practice address

964 El Segundo Dr
Thousand Oaks, CA 91362-2201

Phone

(310) 995-7427

NPI assigned

Jan 7, 2025

Organization subpart

No

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

Authorized official

Name

Dr. Beatrix Sibylle Wagner, PSY.D.NPI 1639358385

Title

Clinical Psychologist/Ceo

Phone

(310) 995-7427

Specialties & licenses 1

Addresses

Other identifiers 4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Beatrix Wagner, PSY.D.

  • Psychologist
  • Fort Worth, TX
  • NPI 1639358385
  NPD Authorized official

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

{
    "created_epoch": "1736208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1275343857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "964 EL SEGUNDO DR",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913622201",
            "telephone_number": "310-995-7427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "964 EL SEGUNDO DR",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913622201",
            "telephone_number": "310-995-7427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROEDGE PSYCHOLOGICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-07",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "BEATRIX",
        "authorized_official_middle_name": "SIBYLLE",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST/CEO",
        "authorized_official_telephone_number": "310-995-7427",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "1639358385",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639358385",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "12409169",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "PG0112723001",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• David J Newman, MD
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• Eric NG, M.D.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.