Provider Demographics
NPI:1053443655
Name:CORNELL, JOSH (PSYD)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:CORNELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 E MOUNTAIN VIEW TER
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4136
Mailing Address - Country:US
Mailing Address - Phone:626-429-5107
Mailing Address - Fax:
Practice Address - Street 1:695 S VERMONT AVE STE 800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1349
Practice Address - Country:US
Practice Address - Phone:213-251-6570
Practice Address - Fax:213-351-2762
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21699103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical