Provider Demographics
NPI:1225220080
Name:HADAR, REBECCA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:HADAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:COWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3200 MOTOR AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3710
Mailing Address - Country:US
Mailing Address - Phone:310-836-1223
Mailing Address - Fax:310-837-6647
Practice Address - Street 1:3200 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3710
Practice Address - Country:US
Practice Address - Phone:310-924-0035
Practice Address - Fax:310-837-6647
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25380103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225220080Medicaid