Healthcare Provider Details

I. General information

NPI: 1487873881
Provider Name (Legal Business Name): ALEXIS DANIELLE KULICK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N PRAIRIE AVE DEPARTMENT OF REHABILITATION
INGLEWOOD CA
90301-4501
US

IV. Provider business mailing address

10790 ROSE AVE #108
LOS ANGELES CA
90034-4440
US

V. Phone/Fax

Practice location:
  • Phone: 310-674-7050
  • Fax: 310-674-3886
Mailing address:
  • Phone: 310-559-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY18860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: