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General NPI Number Information
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NPI Number | 1972146744
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Entity Type | Organization
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Legal Business Name | MAX MAISEL PHD, A PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 14011 VENTURA BLVD STE 203A
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-5273
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Country | US
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Telephone | 213-218-3080
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1625
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City | STUDIO CITY
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State | CA
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Zip | 91614-0625
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Country | US
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Telephone | 858-449-9915
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | MAX EMANUEL MAISEL
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Credential | PHD
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Telephone | 213-218-3080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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