Provider Demographics
NPI:1497969463
Name:SICHER, BONNIE LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LYNN
Last Name:SICHER
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 1:8635 WEST THIRD STREET
Mailing Address - Street 2:SUITE 685W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:310-335-2272
Mailing Address - Fax:818-886-5294
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:SUITE 685W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-335-2272
Practice Address - Fax:818-886-5294
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17680103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical