Provider Demographics
NPI:1083824254
Name:STIMSON, JANICE (PSYD, RAS)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:STIMSON
Suffix:
Gender:F
Credentials:PSYD, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12304 SANTA MONICA BLVD STE 215A
Mailing Address - Street 2:
Mailing Address - City:WEST LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2587
Mailing Address - Country:US
Mailing Address - Phone:310-207-4322
Mailing Address - Fax:310-207-6511
Practice Address - Street 1:12304 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2551
Practice Address - Country:US
Practice Address - Phone:310-207-4322
Practice Address - Fax:310-207-6511
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS0504101451101YA0400X
CA103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)