Healthcare Provider Details

I. General information

NPI: 1902768385
Provider Name (Legal Business Name): BEVERLY HILLS PSYCHOANALYTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 S RODEO DR STE A
BEVERLY HILLS CA
90212-3803
US

IV. Provider business mailing address

249 S RODEO DR STE A
BEVERLY HILLS CA
90212-3803
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-8464
  • Fax:
Mailing address:
  • Phone: 310-550-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name: DR. JILL MODEL BARTH
Title or Position: PRESIDENT
Credential: PHD
Phone: 310-550-8464