Healthcare Provider Details

I. General information

NPI: 1295184760
Provider Name (Legal Business Name): JEFFREY PRAGER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S BEVERLY DR SUITE 100
BEVERLY HILLS CA
90212-4314
US

IV. Provider business mailing address

333 S BEVERLY DR SUITE 100
BEVERLY HILLS CA
90212-4314
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-3743
  • Fax: 310-474-5001
Mailing address:
  • Phone: 310-825-3743
  • Fax: 310-474-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRP-48
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberRP-48
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: