Provider Demographics
NPI:1831234830
Name:RESNICK, MARY (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:RESNICK
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 PARK TERRACE DR
Mailing Address - Street 2:150
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4642
Mailing Address - Country:US
Mailing Address - Phone:818-991-6040
Mailing Address - Fax:
Practice Address - Street 1:4333 PARK TERRACE DR
Practice Address - Street 2:150
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4642
Practice Address - Country:US
Practice Address - Phone:818-991-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13521103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist