Elderly Behavioral Wellness Services Inc

Primary specialty

Adult Development & Aging PsychologistTaxonomy code 103TA0700X

License

PSY22542 Issued in CA

Legal business name

ELDERLY BEHAVIORAL WELLNESS SERVICES INC

Practice address

2001 S Barrington Ave Ste 314
Los Angeles, CA 90025-5379

Phone

(310) 999-9683

NPI assigned

Jan 26, 2015

Organization subpart

No

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

Authorized official

Name

Eleni BagourdiNPI 1447490958

Title

Ceo

Phone

(310) 999-9683

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 4

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

• Eleni Bagourdi, PH.D.

  • Clinical Psychologist
  • Los Angeles, CA
  • NPI 1447490958
  Medicare reassignment Care Compare group NPD Authorized official
• Emi Iijima, PSY.D.

  • Clinical Psychologist
  • South Pasadena, CA
  • NPI 1154551760
  Medicare reassignment Care Compare group NPD
• Antonia M Hickey, PSYD

  • Clinical Psychologist
  • Los Angeles, CA
  • NPI 1255619656
  Medicare reassignment NPD
• Melissa S Stolsig, MS, MA, PSY.D.

  • Clinical Psychologist
  • Sacramento, CA
  • NPI 1881912301

  Adult Development & Aging

  Medicare reassignment NPD

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

{
    "created_epoch": "1422230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1871983106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S BARRINGTON AVE STE 314",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900255379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S BARRINGTON AVE STE 314",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900255379",
            "telephone_number": "310-999-9683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELDERLY BEHAVIORAL WELLNESS SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-26",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "BAGOURDI",
        "authorized_official_first_name": "ELENI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-999-9683"
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "CA",
            "license": "PSY22542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Bertram Elconin, M.D.
• Eld Unlimited Opportunities, Inc
• Jennifer Patrice Elder-Wolff, FNP
• Alyssa Elder, PT
• Charlotte Ebony Elder, M.A.
• Elderly Love Homecare Services LLC
• Amani Eldessouky, M.D.
• Caine Eldridge
• Dena D Eldridge
• Joshua Clifton Eldridge, MD

• Adult Development & Aging Psychologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Adult Development & Aging Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; 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.