Provider Demographics
NPI:1083778963
Name:PANOFSKY, ANNE DAVISON (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:DAVISON
Last Name:PANOFSKY
Suffix:
Gender:F
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:8313 RAINTREE CIR
Mailing Address - Street 2:#208
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4447
Mailing Address - Country:US
Mailing Address - Phone:310-472-4648
Mailing Address - Fax:310-476-4684
Practice Address - Street 1:10801 NATIONAL BLVD
Practice Address - Street 2:STE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4148
Practice Address - Country:US
Practice Address - Phone:310-472-4648
Practice Address - Fax:310-476-4684
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY5325103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPS5325Medicare ID - Type UnspecifiedMEDICARE