Healthcare Provider Details

I. General information

NPI: 1295944718
Provider Name (Legal Business Name): MARY R HULNICK PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 WILSHIRE BLVD
SANTA MONICA CA
90403-5735
US

IV. Provider business mailing address

21130 BELLINI DR
TOPANGA CA
90290-4408
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-7402
  • Fax: 310-453-5641
Mailing address:
  • Phone: 818-999-1589
  • Fax: 818-999-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPU 7219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: