MEDICARE: THE BRAIN PSYCHOLOGIST PC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1932920873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BRAIN PSYCHOLOGIST PC

Provider Business Mailing Address
First Line	:	11301 W OLYMPIC BLVD # 121-430
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1653
Country	:	US
Telephone Number	:	424-234-3032
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 GLENDON AVE APT 301
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4638
Country	:	US
Telephone Number	:	310-933-2864
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL NEUROPSYCHOLOGIST
Name	:	DR. LIORAH SABBAH
Credential	:	PHD
Telephone Number	:	310-933-2864

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	10/23/2024

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