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NPI Code Detail

MEDICARE: DR. ALISA DENNIS PH.D.

MEDICARE: DR. ALISA DENNIS 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
1103TC0700XClinical Psychologist19671CA
2103TC0700XClinical PsychologistPSY19671CA

General Provider Information

NPI Number : 1386760312
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALISA DENNIS PH.D.
Provider Business Mailing Address
First Line : 2046 HILLHURST AVE # 114
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-2719
Country : US
Telephone Number : 818-929-6095
Fax Number :
Provider Business Practice Location Address
First Line : 5887 GLENRIDGE DR STE 230
Second Line :
City : SANDY SPRINGS
State : GA
Zip : 30328-9929
Country : US
Telephone Number : 818-693-7530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 04/08/2024

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Directions to “ DR. ALISA DENNIS PH.D.” Practice Location

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