Provider Demographics
NPI:1568441053
Name:SPERLING, RENEE R (MSW LCSW BCD)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:R
Last Name:SPERLING
Suffix:
Gender:F
Credentials:MSW LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 SANTA MONICA BOULEVARD
Mailing Address - Street 2:SUITE #370
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7532
Mailing Address - Country:US
Mailing Address - Phone:310-470-3450
Mailing Address - Fax:310-397-3934
Practice Address - Street 1:11022 SANTA MONICA BOULEVARD
Practice Address - Street 2:SUITE #370
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7532
Practice Address - Country:US
Practice Address - Phone:310-470-3450
Practice Address - Fax:310-397-3934
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS8489103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW8489OtherCABBSE
R65170Medicare UPIN
CASW8489Medicare ID - Type Unspecified