Provider Demographics
NPI:1134425069
Name:DEVLIN-MORADI, GAIL (PHD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:DEVLIN-MORADI
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 1:116 N ROBERTSON BLVD
Mailing Address - Street 2:SUITE 807
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3103
Mailing Address - Country:US
Mailing Address - Phone:310-652-4257
Mailing Address - Fax:
Practice Address - Street 1:116 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 807
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3103
Practice Address - Country:US
Practice Address - Phone:310-652-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14174103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist