Provider Demographics
NPI:1194750786
Name:HOREVITZ, RICHARD P (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:HOREVITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 N RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3435
Mailing Address - Country:US
Mailing Address - Phone:323-767-6053
Mailing Address - Fax:626-421-6775
Practice Address - Street 1:664 N RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3435
Practice Address - Country:US
Practice Address - Phone:323-767-6053
Practice Address - Fax:626-421-6775
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71006214103TC0700X
CAPSY 21981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632515OtherBLUE CROSS BLUE SHIELD IL
IL364495759OtherFEIN #