Provider Demographics
NPI:1215365747
Name:ROXANNE PRILUTSKY, PH.D., A PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:ROXANNE PRILUTSKY, PH.D., A PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRILUTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-765-3518
Mailing Address - Street 1:835 E MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-1311
Mailing Address - Country:US
Mailing Address - Phone:818-257-4801
Mailing Address - Fax:626-765-3532
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:626-765-3518
Practice Address - Fax:626-765-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25879103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty