Provider Demographics
NPI:1336610260
Name:KAREN S. MAKOFF PHD, CLINICAL PSYCHOLOGIST, PC
Entity Type:Organization
Organization Name:KAREN S. MAKOFF PHD, CLINICAL PSYCHOLOGIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:MAKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-616-5050
Mailing Address - Street 1:12304 SANTA MONICA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2551
Mailing Address - Country:US
Mailing Address - Phone:310-616-5050
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2551
Practice Address - Country:US
Practice Address - Phone:310-616-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty