Healthcare Provider Details

I. General information

NPI: 1508494659
Provider Name (Legal Business Name): NOAH HASS-COHEN PSYD PSYCHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S SAN VICENTE BLVD STE 264
LOS ANGELES CA
90048-4884
US

IV. Provider business mailing address

640 S SAN VICENTE BLVD STE 264
LOS ANGELES CA
90048-4884
US

V. Phone/Fax

Practice location:
  • Phone: 323-717-6546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NOAH HASS-COHEN
Title or Position: OWNER
Credential: PSYD
Phone: 323-717-6546