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General NPI Number Information
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NPI Number | 1992189161
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Entity Type | Organization
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Legal Business Name | CENTER FOR THE DEVELOPING MIND
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 2990 S SEPULVEDA BLVD SUITE 308
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City | LOS ANGELES
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State | CA
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Zip | 90064-0002
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Country | US
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Telephone | 323-428-4639
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Fax |
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Provider Business Mailing Address
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Address Line | 2990 S SEPULVEDA BLVD SUITE 308
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City | LOS ANGELES
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State | CA
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Zip | 90064-0002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ESTHER B HESS
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Credential | PH.D.
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Telephone | 323-428-4639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY#16090
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License Number State | CA
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