Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 107083 | CA |
NPI | 1538755525 |
---|---|
Provider Name | Jason S Batanides |
First Address | Westlake Village, CA 91362-6864 |
Second Address | Westlake Village, CA 91362-6864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2020 |
Last Update Date | 14/12/2020 |