Provider Demographics
NPI:1386266021
Name:RECONNECT RELATIONSHIP, A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity type:Organization
Organization Name:RECONNECT RELATIONSHIP, A PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALEPAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-500-8442
Mailing Address - Street 1:499 N CANON DR STE 216
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4887
Mailing Address - Country:US
Mailing Address - Phone:310-500-8442
Mailing Address - Fax:855-881-3484
Practice Address - Street 1:499 N CANON DR STE 216
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4887
Practice Address - Country:US
Practice Address - Phone:310-500-8442
Practice Address - Fax:855-881-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY23708OtherMEDICAL LICENSE