Provider Demographics
NPI:1992729792
Name:NATHANSON, IRA (PHD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:NATHANSON
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 1:337 S BEVERLY DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4315
Mailing Address - Country:US
Mailing Address - Phone:310-553-0066
Mailing Address - Fax:310-826-8182
Practice Address - Street 1:337 S BEVERLY DR
Practice Address - Street 2:SUITE 209
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4315
Practice Address - Country:US
Practice Address - Phone:310-553-0066
Practice Address - Fax:310-826-8182
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY2825103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP2825Medicare ID - Type UnspecifiedPSYCHOLOGIST