Provider Demographics
NPI:1902992712
Name:DERR, KAREN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M
Last Name:DERR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 WESTWOOD BLVD.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5616
Mailing Address - Country:US
Mailing Address - Phone:310-337-1686
Mailing Address - Fax:310-815-9254
Practice Address - Street 1:1516 WESTWOOD BLVD.
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5616
Practice Address - Country:US
Practice Address - Phone:310-337-1686
Practice Address - Fax:310-815-9254
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13164103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP13164Medicare ID - Type Unspecified