Provider Demographics
NPI:1245425081
Name:MADURO, PETER NICHOLSON (JD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:NICHOLSON
Last Name:MADURO
Suffix:
Gender:M
Credentials:JD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N BEDFORD DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4324
Mailing Address - Country:US
Mailing Address - Phone:310-858-6455
Mailing Address - Fax:310-442-9508
Practice Address - Street 1:450 N BEDFORD DR
Practice Address - Street 2:SUITE 302
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4324
Practice Address - Country:US
Practice Address - Phone:310-858-6455
Practice Address - Fax:310-442-9508
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19531103TC0700X, 103TC1900X, 103TF0200X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis