Healthcare Provider Details

I. General information

NPI: 1225563729
Provider Name (Legal Business Name): BRYCE MCDAVITT PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2017
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11712 MOORPARK ST STE 204B
STUDIO CITY CA
91604-2158
US

IV. Provider business mailing address

11712 MOORPARK ST STE 204B
STUDIO CITY CA
91604-2158
US

V. Phone/Fax

Practice location:
  • Phone: 323-801-8123
  • Fax:
Mailing address:
  • Phone: 323-801-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: