Provider Demographics
NPI:1255666814
Name:PORCHE-ANDERSON, VERONICA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:
Last Name:PORCHE-ANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:PORCHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSY D
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 920E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-601-0702
Mailing Address - Fax:310-659-3824
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 800E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-601-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22912103TB0200X, 103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth