Provider Demographics
NPI:1396258059
Name:L & D PSYCHOLOGICAL ASSOCIATES, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:L & D PSYCHOLOGICAL ASSOCIATES, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:323-813-1634
Mailing Address - Street 1:617 S OLIVE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-1646
Mailing Address - Country:US
Mailing Address - Phone:323-813-1634
Mailing Address - Fax:
Practice Address - Street 1:617 S OLIVE ST STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-1646
Practice Address - Country:US
Practice Address - Phone:323-813-1634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29558103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty