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13130 Burbank Blvd Sherman Oaks CA 91401-6037 | |
| (818) 779-5212 | |
| (818) 779-5167 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 13130 Burbank Blvd, Sherman Oaks, California |
| Authorized Official Name and Position | Susan Ann Berman (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 8187795212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
13130 Burbank Blvd Sherman Oaks CA 91401-6037 Ph: (818) 779-5212 | 13130 Burbank Blvd Sherman Oaks CA 91401-6037 Ph: (818) 779-5212 |
| NPI Number | 1346374881 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 04/21/2016 |
| Medicare PECOS PAC ID | 6901330265 |
|---|---|
| Medicare Enrollment ID | O20241108000974 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346374881 | NPI | - | NPPES |
| 7095 | Other | CA | MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Joshua Mason |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457479966 PECOS PAC ID: 3476913864 Enrollment ID: I20230717002925 |
| Provider Name | Susan Ann Berman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649396706 PECOS PAC ID: 8729512090 Enrollment ID: I20241108001025 |
| Provider Name | Heather Humphrey |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1043778863 PECOS PAC ID: 2264966282 Enrollment ID: I20241114000041 |
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