Provider Demographics
NPI:1144694654
Name:JODY ECHEGARAY, PSY.D. INC.
Entity type:Organization
Organization Name:JODY ECHEGARAY, PSY.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:(JODY)
Authorized Official - Last Name:ECHEGARAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:424-226-8020
Mailing Address - Street 1:8870 HARGIS ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2444
Mailing Address - Country:US
Mailing Address - Phone:424-226-8020
Mailing Address - Fax:
Practice Address - Street 1:1081 WESTWOOD BLVD STE 221
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2925
Practice Address - Country:US
Practice Address - Phone:424-226-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27829103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty