Provider Demographics
NPI:1790809499
Name:PRILUTSKY, ROXANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:PRILUTSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 E. MAGNOLIA BLVD.
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501
Mailing Address - Country:US
Mailing Address - Phone:818-257-4801
Mailing Address - Fax:
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:626-765-3518
Practice Address - Fax:626-765-3532
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25879103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical