Provider Demographics
NPI:1689439804
Name:CENTURY PSYCHOLOGY GROUP
Entity Type:Organization
Organization Name:CENTURY PSYCHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DANESHRAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-633-9167
Mailing Address - Street 1:1134 ALTA LOMA RD APT 203
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2428
Mailing Address - Country:US
Mailing Address - Phone:818-633-9167
Mailing Address - Fax:
Practice Address - Street 1:416 N BEDFORD DR STE 208
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4317
Practice Address - Country:US
Practice Address - Phone:213-342-1026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty