Provider Demographics
NPI:1083833586
Name:KALISH-WEISS, BETH I (PHD, FIPA)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:I
Last Name:KALISH-WEISS
Suffix:
Gender:F
Credentials:PHD, FIPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6433 TAHOE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1655
Mailing Address - Country:US
Mailing Address - Phone:323-463-1844
Mailing Address - Fax:323-463-5707
Practice Address - Street 1:6433 TAHOE DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1655
Practice Address - Country:US
Practice Address - Phone:323-463-1844
Practice Address - Fax:323-463-5707
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9535103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP9535CMedicare ID - Type UnspecifiedPROVIDER