Provider Demographics
NPI:1649541749
Name:MOLKO, RONIT (PHD, BCBA-D)
Entity type:Individual
Prefix:
First Name:RONIT
Middle Name:
Last Name:MOLKO
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:RONIT
Other - Middle Name:
Other - Last Name:GERSHATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6059 BRISTOL PKWY
Mailing Address - Street 2:#100
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6663
Mailing Address - Country:US
Mailing Address - Phone:310-641-1100
Mailing Address - Fax:310-641-1174
Practice Address - Street 1:6059 BRISTOL PKWY
Practice Address - Street 2:#100
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6663
Practice Address - Country:US
Practice Address - Phone:310-641-1100
Practice Address - Fax:310-641-1174
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2014-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-99-0115103K00000X
CAPSY18332103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist