Healthcare Provider Details

I. General information

NPI: 1972667855
Provider Name (Legal Business Name): ALICE R BERKOWITZ PHD, A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST 920 EAST
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

8631 W 3RD ST 920 EAST
LOS ANGELES CA
90048-5901
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-3824
  • Fax:
Mailing address:
  • Phone: 310-659-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY9223
License Number StateCA

VIII. Authorized Official

Name: DR. ALICE BERKOWITZ
Title or Position: PRESIDENT
Credential: PH.D
Phone: 310-659-3824