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General NPI Number Information
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NPI Number | 1528517786
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Entity Type | Organization
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Legal Business Name | MARA TANSMAN, PSY.D. A PROFESSIONAL PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 10323 SANTA MONICA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025-6071
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Country | US
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Telephone | 310-734-0306
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 S CASTELLO AVE
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City | LOS ANGELES
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State | CA
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Zip | 90035-2807
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Country | US
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Telephone | 310-734-0306
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARA TANSMAN
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Credential | PSY.D.
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Telephone | 310-734-0306
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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 | PSY16710
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License Number State | CA
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