MEDICARE: EVELYN PECHTER PSYD

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
1	103T00000X	Psychologist	PSY21132	CA

General Provider Information

NPI Number	:	1841595683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVELYN PECHTER PSYD

Provider Business Mailing Address
First Line	:	4712 ADMIRALTY WAY
Second Line	:	SUITE 917
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6905
Country	:	US
Telephone Number	:	310-622-5741
Fax Number	:	310-765-6342

Provider Business Practice Location Address
First Line	:	9911 WEST PICO BLVD
Second Line	:	SUITE 1050
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-2712
Country	:	US
Telephone Number	:	310-622-5741
Fax Number	:	310-765-6342

Authorized Official
Title or Position	:	OWNER
Name	:	EVELYN PECHTER
Credential	:	PSYD
Telephone Number	:	310-622-5741

Provider Enumeration Date	:	01/25/2011
Last Update Date	:	01/25/2011

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