Provider Demographics
NPI:1760582399
Name:WELANETZ-BURSIN, LEXI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEXI
Middle Name:
Last Name:WELANETZ-BURSIN
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 1:11500 W OLYMPIC BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1564
Mailing Address - Country:US
Mailing Address - Phone:310-479-9798
Mailing Address - Fax:310-479-9796
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 420
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1564
Practice Address - Country:US
Practice Address - Phone:310-479-9798
Practice Address - Fax:310-479-9796
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16306103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP16306AMedicare ID - Type Unspecified