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NPI Code Detail

MEDICARE: MARA TANSMAN, PSY.D. A PROFESSIONAL PSYCHOLOGICAL CORPORATION

MEDICARE: MARA TANSMAN, PSY.D. A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY16710CA

General Provider Information

NPI Number : 1528517786
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARA TANSMAN, PSY.D. A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Provider Business Mailing Address
First Line : 1445 S CASTELLO AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90035-2807
Country : US
Telephone Number : 310-734-0306
Fax Number :
Provider Business Practice Location Address
First Line : 10323 SANTA MONICA BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-6071
Country : US
Telephone Number : 310-734-0306
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARA TANSMAN
Credential : PSY.D.
Telephone Number : 310-734-0306
Provider Enumeration Date : 09/29/2016
Last Update Date : 09/29/2016

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Directions to “MARA TANSMAN, PSY.D. A PROFESSIONAL PSYCHOLOGICAL CORPORATION ” Practice Location

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