Provider Demographics
NPI:1013345651
Name:BRUCE I. DERMAN PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:BRUCE I. DERMAN PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:I
Authorized Official - Last Name:DERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-348-5133
Mailing Address - Street 1:23011 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3232
Mailing Address - Country:US
Mailing Address - Phone:818-348-5133
Mailing Address - Fax:818-704-1453
Practice Address - Street 1:23011 OXNARD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3232
Practice Address - Country:US
Practice Address - Phone:818-348-5133
Practice Address - Fax:818-704-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-3246305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization