MEDICARE: DR. VANESSA KATZ PSY.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	PSY 22231	CA

General Provider Information

NPI Number	:	1679792030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA KATZ PSY.D.

Provider Business Mailing Address
First Line	:	1710 CALIFORNIA AVE APT 5
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4473
Country	:	US
Telephone Number	:	310-360-0164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1334 WESTWOOD BLVD STE 5
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4951
Country	:	US
Telephone Number	:	310-266-0855
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	11/04/2008

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