Healthcare Provider Details

I. General information

NPI: 1699196956
Provider Name (Legal Business Name): RONECIA LARK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W FLORENCE AVE
INGLEWOOD CA
90301-1103
US

IV. Provider business mailing address

8939 S SEPULVEDA BLVD STE 110-746
WESTCHESTER CA
90045-3631
US

V. Phone/Fax

Practice location:
  • Phone: 424-261-0141
  • Fax:
Mailing address:
  • Phone: 424-261-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY30368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: