Healthcare Provider Details

I. General information

NPI: 1124266283
Provider Name (Legal Business Name): MERYLE HOPE GELLMAN PH.D., PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S BRISTOL AVE
LOS ANGELES CA
90049-4901
US

IV. Provider business mailing address

707 S BRISTOL AVE
LOS ANGELES CA
90049-4901
US

V. Phone/Fax

Practice location:
  • Phone: 310-264-3845
  • Fax: 310-264-3846
Mailing address:
  • Phone: 310-264-3845
  • Fax: 310-264-3846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT7676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: