Provider Demographics
NPI:1679792030
Name:KATZ, VANESSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 CALIFORNIA AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4473
Mailing Address - Country:US
Mailing Address - Phone:310-360-0164
Mailing Address - Fax:
Practice Address - Street 1:1334 WESTWOOD BLVD STE 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4951
Practice Address - Country:US
Practice Address - Phone:310-266-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical