Provider Demographics
NPI:1588085328
Name:LINA SUCHOV A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity type:Organization
Organization Name:LINA SUCHOV A PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCHOV
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-385-0336
Mailing Address - Street 1:16260 VENTURA BLVD
Mailing Address - Street 2:SUITE LLE 30
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4927
Mailing Address - Country:US
Mailing Address - Phone:818-385-0336
Mailing Address - Fax:818-385-1310
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:SUITE LLE 30
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2203
Practice Address - Country:US
Practice Address - Phone:818-385-0336
Practice Address - Fax:818-385-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14451103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14451OtherPSY