Provider Demographics
NPI:1356614325
Name:GOLANT, MAURICE CALVIN (PHD)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:CALVIN
Last Name:GOLANT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:MITCH
Other - Middle Name:
Other - Last Name:GOLANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:12011 SAN VICENTE BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4946
Mailing Address - Country:US
Mailing Address - Phone:310-472-4648
Mailing Address - Fax:310-476-4684
Practice Address - Street 1:12011 SAN VICENTE BLVD STE 402
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4946
Practice Address - Country:US
Practice Address - Phone:310-472-4648
Practice Address - Fax:310-472-3161
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 7991103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist