Provider Demographics
NPI:1467535997
Name:RENO, ROCHELLE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:MARIE
Last Name:RENO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 COLBY AVE
Mailing Address - Street 2:#203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4187
Mailing Address - Country:US
Mailing Address - Phone:310-479-3490
Mailing Address - Fax:
Practice Address - Street 1:3201 WILSHIRE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2337
Practice Address - Country:US
Practice Address - Phone:310-774-6104
Practice Address - Fax:310-693-8106
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical