Provider Demographics
NPI:1992938278
Name:GERIATRIC EVALUATION & NEUROPSYCHOLOGICAL SERVICES, INC
Entity type:Organization
Organization Name:GERIATRIC EVALUATION & NEUROPSYCHOLOGICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENA
Authorized Official - Middle Name:AVITAL
Authorized Official - Last Name:KRAVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-314-8088
Mailing Address - Street 1:18375 VENTURA BLVD
Mailing Address - Street 2:578
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4218
Mailing Address - Country:US
Mailing Address - Phone:818-314-8088
Mailing Address - Fax:818-708-8498
Practice Address - Street 1:15235 BURBANK BLVD
Practice Address - Street 2:A4
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-3500
Practice Address - Country:US
Practice Address - Phone:818-314-8088
Practice Address - Fax:818-708-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21989103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty