MEDICARE: DR. BARBARA WITLIN GUGGENHEIM 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	PSY4479	CA

General Provider Information

NPI Number	:	1104032077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA WITLIN GUGGENHEIM PH.D

Provider Business Mailing Address
First Line	:	11726 SAN VICENTE BLVD STE 680
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5049
Country	:	US
Telephone Number	:	310-820-8655
Fax Number	:	310-471-3346

Provider Business Practice Location Address
First Line	:	11726 SAN VICENTE BLVD STE 680
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5049
Country	:	US
Telephone Number	:	310-820-8655
Fax Number	:	310-471-3346

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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