Provider Demographics
NPI:1184631723
Name:BANDER, RICKI S (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICKI
Middle Name:S
Last Name:BANDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 1/2 WESTWOOD BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-470-1435
Mailing Address - Fax:310-470-2135
Practice Address - Street 1:1923 1/2 WESTWOOD BLVD
Practice Address - Street 2:STE 4
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-470-1435
Practice Address - Fax:310-470-2135
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7652103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist