Provider Demographics
NPI:1235727454
Name:TRANSFORM PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:TRANSFORM PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLOSSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-924-9117
Mailing Address - Street 1:7727 W MANCHESTER AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8938
Mailing Address - Country:US
Mailing Address - Phone:310-924-9117
Mailing Address - Fax:
Practice Address - Street 1:2116 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5747
Practice Address - Country:US
Practice Address - Phone:310-924-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty