Healthcare Provider Details

I. General information

NPI: 1386164184
Provider Name (Legal Business Name): ALLSTATE PSYCHOLOGICAL AND BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 WILSHIRE BLVD STE 720
LOS ANGELES CA
90010-3825
US

IV. Provider business mailing address

4929 WILSHIRE BLVD STE 720
LOS ANGELES CA
90010-3825
US

V. Phone/Fax

Practice location:
  • Phone: 718-338-3690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL RUBENSTEIN
Title or Position: OWNER
Credential: PHD
Phone: 323-688-6712