Provider Demographics
NPI:1114169190
Name:DAVID PLOTKIN, PH.D.
Entity Type:Organization
Organization Name:DAVID PLOTKIN, PH.D.
Other - Org Name:DAVID PLOTKIN, PH.D. AND ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-470-9994
Mailing Address - Street 1:16055 VENTURA BLVD STE 715
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2610
Mailing Address - Country:US
Mailing Address - Phone:310-470-9994
Mailing Address - Fax:310-882-6820
Practice Address - Street 1:16055 VENTURA BLVD STE 715
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2610
Practice Address - Country:US
Practice Address - Phone:310-470-9994
Practice Address - Fax:310-882-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19818103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP19818Medicare PIN