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General NPI Number Information
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NPI Number | 1518000355
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Entity Type | Organization
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Legal Business Name | UCLA PSYCHOLOGY CLINIC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | UCLA PSYCHOLOGY CLINIC 2191 FRANZ HALL BOX 951563
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City | LOS ANGELES
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State | CA
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Zip | 90095-1563
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Country | US
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Telephone | 310-825-2305
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Fax | 310-825-2306
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Provider Business Mailing Address
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Address Line | UCLA PSYCHOLOGY CLINIC 2191 FRANZ HALL BOX 951563
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City | LOS ANGELES
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State | CA
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Zip | 90095-1563
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Country | US
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Telephone | 310-825-2305
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Fax | 310-825-2306
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Authorized Official
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Title or Position | CLINIC COORDINATOR
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Name | DR. JILL WATERMAN
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Credential | PH.D.
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Telephone | 310-825-2305
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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 | PSY 6144
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License Number State | CA
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