Provider Demographics
NPI:1376959429
Name:LOS ANGELES BDD & BODY IMAGE CLINIC
Entity Type:Organization
Organization Name:LOS ANGELES BDD & BODY IMAGE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINOGRAD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-741-2000
Mailing Address - Street 1:10780 SANTA MONICA BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7613
Mailing Address - Country:US
Mailing Address - Phone:310-741-2000
Mailing Address - Fax:888-239-6367
Practice Address - Street 1:10780 SANTA MONICA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7613
Practice Address - Country:US
Practice Address - Phone:310-741-2000
Practice Address - Fax:888-239-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39567106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty