| Clinical Therapy Center | |
|
1816 Prosser Ave Apt 4 Los Angeles CA 90025-4829 | |
| (310) 420-9690 | |
| (888) 919-2887 |
| Full Name | Clinical Therapy Center |
|---|---|
| Speciality | Psychologist |
| Location | 1816 Prosser Ave Apt 4, Los Angeles, California |
| Authorized Official Name and Position | Roni B Maccabee (PRESIDENT) |
| Authorized Official Contact | 3104209690 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinical Therapy Center 200 S Barrington Ave # 511 Los Angeles CA 90049-7939 Ph: (310) 420-9690 | Clinical Therapy Center 1816 Prosser Ave Apt 4 Los Angeles CA 90025-4829 Ph: (310) 420-9690 |
| NPI Number | 1831782077 |
|---|---|
| Provider Enumeration Date | 02/18/2021 |
| Last Update Date | 06/08/2023 |
| Certification Date | 06/08/2023 |
| Medicare PECOS PAC ID | 2062828411 |
|---|---|
| Medicare Enrollment ID | O20210309002135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831782077 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Roni B Maccabee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093931115 PECOS PAC ID: 7416363866 Enrollment ID: I20210309002439 |
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