Provider Demographics
NPI:1477672616
Name:MISHKIN, HOWARD (PHD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:MISHKIN
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 1:6651 BALBOA BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5529
Mailing Address - Country:US
Mailing Address - Phone:213-694-0045
Mailing Address - Fax:
Practice Address - Street 1:6651 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5529
Practice Address - Country:US
Practice Address - Phone:818-997-2640
Practice Address - Fax:818-609-7488
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18247103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist