Healthcare Provider Details

I. General information

NPI: 1598804783
Provider Name (Legal Business Name): RENE DJ HOLLANDER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12030 W WASHINGTON BLVD SUITE C
LOS ANGELES CA
90066-2618
US

IV. Provider business mailing address

578 WASHINGTON BLVD SUITE 703
MARINA DEL REY CA
90292-5421
US

V. Phone/Fax

Practice location:
  • Phone: 310-390-6140
  • Fax:
Mailing address:
  • Phone: 310-821-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 16826
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 16826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: