Provider Demographics
NPI:1952512428
Name:MCCULLOCH, CLAUDIA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:R
Last Name:MCCULLOCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CLAUDIA
Other - Middle Name:R
Other - Last Name:JACOBOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:29441 S BAYEND DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1102
Mailing Address - Country:US
Mailing Address - Phone:310-833-7894
Mailing Address - Fax:310-833-7746
Practice Address - Street 1:29000 S WESTERN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0818
Practice Address - Country:US
Practice Address - Phone:310-514-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP 2127103TB0200X, 103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities