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General NPI Number Information
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NPI Number | 1831782077
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Entity Type | Organization
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Legal Business Name | RONI MACCABEE PSYCHOLOGICAL PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 1816 PROSSER AVE APT 4
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City | LOS ANGELES
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State | CA
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Zip | 90025-4829
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Country | US
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Telephone | 310-420-9690
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Fax | 888-919-2887
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Provider Business Mailing Address
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Address Line | 200 S BARRINGTON AVE # 511
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City | LOS ANGELES
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State | CA
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Zip | 90049-7939
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Country | US
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Telephone | 310-420-9690
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Fax | 888-919-2887
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONI B MACCABEE
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Credential | PHD
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Telephone | 310-420-9690
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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 |
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License Number State |
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