Provider Demographics
NPI:1275604274
Name:CORTEX BEHAVIORAL HEALTH, CORP.
Entity Type:Organization
Organization Name:CORTEX BEHAVIORAL HEALTH, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-995-4477
Mailing Address - Street 1:17337 VENTURA BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4926
Mailing Address - Country:US
Mailing Address - Phone:818-995-4477
Mailing Address - Fax:818-995-4171
Practice Address - Street 1:17337 VENTURA BLVD STE 206
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4926
Practice Address - Country:US
Practice Address - Phone:818-995-4477
Practice Address - Fax:818-995-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13806103G00000X, 103T00000X
CAPSY10973103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEMPLOYER IDENTIFICATION #