MEDICARE: DR. MAXWELL RAPPOPORT 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	103T00000X	Psychologist
2	103TC0700X	Clinical Psychologist	29385	CA

General Provider Information

NPI Number	:	1659767507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAXWELL RAPPOPORT PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 5106
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91413-5106
Country	:	US
Telephone Number	:	310-426-8104
Fax Number	:

Provider Business Practice Location Address
First Line	:	10880 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4101
Country	:	US
Telephone Number	:	310-955-1352
Fax Number	:

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

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	01/16/2026

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