Provider Demographics
NPI:1376573758
Name:SLATER, HAROLD ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:ROBERT
Last Name:SLATER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 CHISLEHURST DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1049
Mailing Address - Country:US
Mailing Address - Phone:323-660-2829
Mailing Address - Fax:323-665-5646
Practice Address - Street 1:2400 CHISLEHURST DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-1049
Practice Address - Country:US
Practice Address - Phone:323-660-2829
Practice Address - Fax:323-665-5646
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11033103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP11033Medicare ID - Type Unspecified