Provider Demographics
NPI:1356883060
Name:TEPPER, NINA (PHD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:TEPPER
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 1:10323 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6071
Mailing Address - Country:US
Mailing Address - Phone:310-918-3834
Mailing Address - Fax:
Practice Address - Street 1:10323 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6071
Practice Address - Country:US
Practice Address - Phone:310-918-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16480103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent