Provider Demographics
NPI:1003967209
Name:HIMELSTEIN, SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:HIMELSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9107 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5508
Mailing Address - Country:US
Mailing Address - Phone:310-247-9447
Mailing Address - Fax:323-299-2988
Practice Address - Street 1:9107 WILSHIRE BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5508
Practice Address - Country:US
Practice Address - Phone:310-247-9447
Practice Address - Fax:323-299-2988
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10619103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical