Provider Demographics
NPI:1699824029
Name:STORM, ANITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:STORM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:ISRAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:435 N BEDFORD DR
Mailing Address - Street 2:S 207
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4356
Mailing Address - Country:US
Mailing Address - Phone:310-276-1610
Mailing Address - Fax:310-276-5570
Practice Address - Street 1:435 N BEDFORD DR
Practice Address - Street 2:S 207
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4356
Practice Address - Country:US
Practice Address - Phone:310-276-1610
Practice Address - Fax:310-276-5570
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DPL107360Medicare UPIN
CP10736Medicare ID - Type Unspecified