Provider Demographics
NPI:1477893675
Name:LABEAUNE, RITA (PSYD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:LABEAUNE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 SAN VICENTE BLVD STE 425
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5446
Mailing Address - Country:US
Mailing Address - Phone:310-773-0043
Mailing Address - Fax:310-300-0336
Practice Address - Street 1:6310 SAN VICENTE BLVD STE 425
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5446
Practice Address - Country:US
Practice Address - Phone:310-773-0043
Practice Address - Fax:310-300-0336
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHB522AMedicare PIN