Provider Demographics
NPI:1124043179
Name:BITTER, EDWARD JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:BITTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:17115 WILLIAMS OAK DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4543
Mailing Address - Country:US
Mailing Address - Phone:310-277-0190
Mailing Address - Fax:281-758-5400
Practice Address - Street 1:19634 VENTURA BLVD
Practice Address - Street 2:STE. 325
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2966
Practice Address - Country:US
Practice Address - Phone:818-345-2341
Practice Address - Fax:818-345-7736
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY043401103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5422000PL43400OtherBLUE SHIELD OF CALIFORNIA
CAPSY043401Medicaid
CAPSY043401Medicaid