MEDICARE: DR. RICHARD P HOREVITZ 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	71006214	IL
2	103TC0700X	Clinical Psychologist	PSY 21981	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01632515	OTHER	IL	BLUE CROSS BLUE SHIELD IL
2	364495759	OTHER	IL	FEIN #

General Provider Information

NPI Number	:	1194750786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD P HOREVITZ PH.D.

Provider Business Mailing Address
First Line	:	664 N RAYMOND AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3435
Country	:	US
Telephone Number	:	323-767-6053
Fax Number	:	626-421-6775

Provider Business Practice Location Address
First Line	:	664 N RAYMOND AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-3435
Country	:	US
Telephone Number	:	323-767-6053
Fax Number	:	626-421-6775

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/07/2015

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