Provider Demographics
NPI:1104365873
Name:NELKIN, VIANNAE CARMONA (PSYD, BCABA)
Entity type:Individual
Prefix:
First Name:VIANNAE
Middle Name:CARMONA
Last Name:NELKIN
Suffix:
Gender:
Credentials:PSYD, BCABA
Other - Prefix:
Other - First Name:VIANNAE
Other - Middle Name:
Other - Last Name:CARMONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:8549 WILSHIRE BLVD STE 1296
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3104
Mailing Address - Country:US
Mailing Address - Phone:424-274-0507
Mailing Address - Fax:
Practice Address - Street 1:930 S ROBERTSON BLVD STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1642
Practice Address - Country:US
Practice Address - Phone:424-274-0507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-14-6039106E00000X
CA35541103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst