Provider Demographics
NPI:1013049105
Name:HANIN, GENINE IVY (EDD)
Entity type:Individual
Prefix:DR
First Name:GENINE
Middle Name:IVY
Last Name:HANIN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 E THOUSAND OAKS BLVD STE 236
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3571
Mailing Address - Country:US
Mailing Address - Phone:805-497-6137
Mailing Address - Fax:
Practice Address - Street 1:3625 E THOUSAND OAKS BLVD
Practice Address - Street 2:120
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3626
Practice Address - Country:US
Practice Address - Phone:805-497-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13568103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR16720Medicare UPIN
CACP13568Medicare ID - Type Unspecified