Active NPI
Denise Ajalat Theberge, PH.D.
- Family Psychologist
- Newhall, CA
National Provider Identifier
1851584528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Psychologist
- License
- PSY16031
- Practice address
- 23030 Lyons Ave
# 202
Newhall, CA 91321-2752 - Phone
- (661) 254-3577
- NPI assigned
- Aug 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Psychologist | 103TF0000X | PSY16031 | CA | Primary |
Addresses
Primary practice location
23030 Lyons Ave
# 202
Newhall, CA 91321-2752
Mailing address
23030 Lyons Ave
# 202
Newhall, CA 91321-2752
Phone (661) 254-3577
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY16031 | CA | MD | Family Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187913600000",
"number": "1851584528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23030 LYONS AVE",
"address_2": "# 202",
"city": "NEWHALL",
"state": "CA",
"postal_code": "913212752",
"telephone_number": "661-254-3577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23030 LYONS AVE",
"address_2": "# 202",
"city": "NEWHALL",
"state": "CA",
"postal_code": "913212752",
"telephone_number": "661-254-3577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEBERGE",
"first_name": "DENISE",
"middle_name": "AJALAT",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-24",
"last_updated": "2007-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "CA",
"license": "PSY16031",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newhall, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.