Provider Demographics
NPI:1598102634
Name:GERIATRIC PSYCHOLOGICAL SERVICES MTCA CA PC
Entity Type:Organization
Organization Name:GERIATRIC PSYCHOLOGICAL SERVICES MTCA CA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-923-1518
Mailing Address - Street 1:5601 OSTROM AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1405
Mailing Address - Country:US
Mailing Address - Phone:310-923-1518
Mailing Address - Fax:
Practice Address - Street 1:5601 OSTROM AVE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1405
Practice Address - Country:US
Practice Address - Phone:310-923-1518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty