Provider Demographics
NPI:1831782077
Name:RONI MACCABEE PSYCHOLOGICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RONI MACCABEE PSYCHOLOGICAL PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONI
Authorized Official - Middle Name:B
Authorized Official - Last Name:MACCABEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-420-9690
Mailing Address - Street 1:200 S BARRINGTON AVE # 511
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-7939
Mailing Address - Country:US
Mailing Address - Phone:310-420-9690
Mailing Address - Fax:888-919-2887
Practice Address - Street 1:1816 PROSSER AVE APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4829
Practice Address - Country:US
Practice Address - Phone:310-420-9690
Practice Address - Fax:888-919-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty