Provider Demographics
NPI:1528202298
Name:FALKE, ROBERTA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:L
Last Name:FALKE
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 1:11400 W OLYMPIC BLVD
Mailing Address - Street 2:# 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1550
Mailing Address - Country:US
Mailing Address - Phone:310-273-5266
Mailing Address - Fax:
Practice Address - Street 1:11400 W OLYMPIC BLVD
Practice Address - Street 2:# 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1550
Practice Address - Country:US
Practice Address - Phone:310-273-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-26
Last Update Date:2009-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical