Jean Anita Pederson, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY11446 Issued in CA

Practice address

6345 Balboa Blvd
Suite 212
Encino, CA 91316-1517

Phone

(818) 881-1928

Fax

(818) 541-9816

NPI assigned

Jan 2, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Jean Anita Hardesty Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Dr. Staci Wold Psychological Services Corporation

  • Clinical Psychologist
  • Encino, CA
  • NPI 1093643439
  NPD (past)
• Mpower, Inc

  • Group Psychotherapy Psychologist
  • Encino, CA
  • NPI 1700661899
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278374400000",
    "number": "1639236391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 EMANUEL DR",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912081135",
            "telephone_number": "818-248-8571",
            "fax_number": "818-541-9816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6345 BALBOA BLVD",
            "address_2": "SUITE 212",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913161517",
            "telephone_number": "818-881-1928",
            "fax_number": "818-541-9816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "JEAN",
        "middle_name": "ANITA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2010-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY11446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEAN",
            "last_name": "HARDESTY",
            "middle_name": "ANITA",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Payam Vahedifar MD Inc
• Khodam-Rad Payman, M.D.
• Diana Lisa Payne, PH.D.
• Jeanne Paz, OTR
• Shivon D Pazos
• Pedes Vascular San Fernando Valley
• Pediatric Acute Care Medical Associates, Inc.
• Pediatric and Family Medical Center (Eisner Health Optometry at Encino)
• Pediatric Cardiology Medical Assoc. of So. California
• Pediatric Care Physicians a Professional Medical Corporation

• Clinical Psychologist in Encino, CA
• Providers in Encino, 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 6, 2010; 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.