Provider Demographics
NPI:1689725574
Name:ELLIOTT, ROBERT WILLIAM (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
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Mailing Address - Street 1:5777 W CENTURY BLVD STE 1645B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5696
Mailing Address - Country:US
Mailing Address - Phone:310-545-6400
Mailing Address - Fax:310-939-7065
Practice Address - Street 1:5777 W CENTURY BLVD STE 1645B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5696
Practice Address - Country:US
Practice Address - Phone:310-545-6400
Practice Address - Fax:310-939-7065
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5107103G00000X
HI711103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist