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General NPI Number Information
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NPI Number | 1184641805
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Entity Type | Individual
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Provider Name | STACY BERLIN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 06/21/2010
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Provider Practice Location Address
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Address Line | 12301 WILSHIRE BLVD SUITE 210
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City | WEST LOS ANGELES
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State | CA
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Zip | 90025-1007
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Country | US
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Telephone | 310-442-6466
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Fax |
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Provider Business Mailing Address
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Address Line | 4223 VANTAGE AVE
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City | STUDIO CITY
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State | CA
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Zip | 91604-2066
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Country | US
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Telephone | 310-442-6466
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY16878
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License Number State | CA
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