Provider Demographics
NPI:1629602750
Name:SHALVA, A PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:SHALVA, A PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAHAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-468-1216
Mailing Address - Street 1:106 N ORANGE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3015
Mailing Address - Country:US
Mailing Address - Phone:917-468-1216
Mailing Address - Fax:
Practice Address - Street 1:4221 WILSHIRE BOULEVLARD
Practice Address - Street 2:SUITE 170B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:323-230-0890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty