Provider Demographics
NPI:1073363719
Name:LOUISIUS, BERLYNE
Entity type:Individual
Prefix:
First Name:BERLYNE
Middle Name:
Last Name:LOUISIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 SANTA MONICA BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:W HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5969
Mailing Address - Country:US
Mailing Address - Phone:323-366-2966
Mailing Address - Fax:
Practice Address - Street 1:8235 SANTA MONICA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:W HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5969
Practice Address - Country:US
Practice Address - Phone:323-366-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031629363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health