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NPI Code Detail

MEDICARE: DR. SONIA HERTEN-GREAVEN PH.D.

MEDICARE: DR. SONIA HERTEN-GREAVEN 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
1103T00000XPsychologistPSY20962CA
2103TC0700XClinical PsychologistPSY20962CA
3103TC2200XClinical Child & Adolescent PsychologistPSY20962CA

General Provider Information

NPI Number : 1568525467
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SONIA HERTEN-GREAVEN PH.D.
Provider Business Mailing Address
First Line : 23632 CALABASAS RD STE 202
Second Line :
City : CALABASAS
State : CA
Zip : 91302-1737
Country : US
Telephone Number : 818-797-4653
Fax Number : 747-226-0291
Provider Business Practice Location Address
First Line : 23632 CALABASAS RD STE 202
Second Line :
City : CALABASAS
State : CA
Zip : 91302-1737
Country : US
Telephone Number : 818-797-4653
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 09/30/2017

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