Provider Demographics
NPI:1649452103
Name:SOBEL, JULIANNE MAE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:MAE
Last Name:SOBEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9173 AIRDROME ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4238
Mailing Address - Country:US
Mailing Address - Phone:310-858-7733
Mailing Address - Fax:310-273-1818
Practice Address - Street 1:9171 WILSHIRE BLVD
Practice Address - Street 2:PENTHOUSE
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5530
Practice Address - Country:US
Practice Address - Phone:310-858-7733
Practice Address - Fax:310-273-1818
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11412103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP11412COtherMEDICARE PROVIDER NUMBER