Provider Demographics
NPI:1467674739
Name:SUSAN B KREVOY EATING DISORDERS PROGRAM AT WRIGHT INSTITUTE
Entity Type:Organization
Organization Name:SUSAN B KREVOY EATING DISORDERS PROGRAM AT WRIGHT INSTITUTE
Other - Org Name:WRIGHT INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KREVOY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-277-2796
Mailing Address - Street 1:9911 WEST PICO BOULEVARD
Mailing Address - Street 2:SUITE 720
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2709
Mailing Address - Country:US
Mailing Address - Phone:310-277-2796
Mailing Address - Fax:310-277-8903
Practice Address - Street 1:9911 WEST PICO BOULEVARD
Practice Address - Street 2:SUITE 720
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2709
Practice Address - Country:US
Practice Address - Phone:310-277-2796
Practice Address - Fax:310-277-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty