Healthcare Provider Details

I. General information

NPI: 1659767507
Provider Name (Legal Business Name): MAXWELL RAPPOPORT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 WESTWOOD PLAZA STE 2437
LOS ANGELES CA
90095-1411
US

IV. Provider business mailing address

PO BOX 5106
SHERMAN OAKS CA
91413-5106
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-0768
  • Fax:
Mailing address:
  • Phone: 818-330-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: