Healthcare Provider Details

I. General information

NPI: 1588893754
Provider Name (Legal Business Name): ELENOR BEROOKHIM DANESHVAR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 SAN VICENTE BLVD #106
LOS ANGELES CA
90049-6511
US

IV. Provider business mailing address

11633 SAN VICENTE BLVD #106
LOS ANGELES CA
90049-6511
US

V. Phone/Fax

Practice location:
  • Phone: 310-207-1720
  • Fax: 310-207-1638
Mailing address:
  • Phone: 310-207-1720
  • Fax: 310-207-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: