Provider Demographics
NPI:1962635045
Name:ADLER, PHILIP (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:ADLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16350 VENTURA BLVD
Mailing Address - Street 2:UNIT D-315
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-5300
Mailing Address - Country:US
Mailing Address - Phone:310-571-5779
Mailing Address - Fax:
Practice Address - Street 1:16350 VENTURA BLVD
Practice Address - Street 2:UNIT D-315
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-5300
Practice Address - Country:US
Practice Address - Phone:310-571-5779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 225C00000X, 390200000X
CA26328103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program