Healthcare Provider Details

I. General information

NPI: 1285822973
Provider Name (Legal Business Name): BARRY HALOTE I PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16311 VENTURA BLVD. SUITE #1050
ENCINO CA
91436
US

IV. Provider business mailing address

P.O. BOX 4368
VALLEY VILLAGE CA
91617
US

V. Phone/Fax

Practice location:
  • Phone: 818-752-3330
  • Fax: 818-508-4820
Mailing address:
  • Phone: 818-752-3330
  • Fax: 818-508-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: