Provider Demographics
NPI:1164405916
Name:SCHOR, JOHANNA (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:
Last Name:SCHOR
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1749
Mailing Address - Country:US
Mailing Address - Phone:323-658-6120
Mailing Address - Fax:
Practice Address - Street 1:566 S SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4650
Practice Address - Country:US
Practice Address - Phone:323-658-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9005103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP9005Medicare ID - Type UnspecifiedPSYCHOLOGY