Provider Demographics
NPI:1336236181
Name:SMALL, TREVOR Z (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:Z
Last Name:SMALL
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 1:450 N. BEDFORD DR.STE. 206
Mailing Address - Street 2:STE. 206
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-275-1013
Mailing Address - Fax:310-275-1232
Practice Address - Street 1:450 N. BEDFORD DR.STE. 206
Practice Address - Street 2:STE. 206
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-275-1013
Practice Address - Fax:310-275-1232
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17516103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist