MEDICARE: DR. SUSAN HIMELSTEIN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 10619	CA

General Provider Information

NPI Number	:	1003967209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN HIMELSTEIN PH.D.

Provider Business Mailing Address
First Line	:	9107 WILSHIRE BLVD
Second Line	:	SUITE 215
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5508
Country	:	US
Telephone Number	:	310-247-9447
Fax Number	:	323-299-2988

Provider Business Practice Location Address
First Line	:	9107 WILSHIRE BLVD
Second Line	:	SUITE 215
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5508
Country	:	US
Telephone Number	:	310-247-9447
Fax Number	:	323-299-2988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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