Provider Demographics
NPI:1386182046
Name:CHANTEL CORTINOVIS, PSY.D., A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:CHANTEL CORTINOVIS, PSY.D., A PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTINOVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:323-250-2461
Mailing Address - Street 1:1081 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2911
Mailing Address - Country:US
Mailing Address - Phone:323-250-2461
Mailing Address - Fax:
Practice Address - Street 1:1081 WESTWOOD BLVD
Practice Address - Street 2:SUITE 221
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2911
Practice Address - Country:US
Practice Address - Phone:323-250-2461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28895251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health