Provider Demographics
NPI:1396520243
Name:KOVITCH, JOSETTA ROSE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSETTA
Middle Name:ROSE
Last Name:KOVITCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 MARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1238
Mailing Address - Country:US
Mailing Address - Phone:213-447-9636
Mailing Address - Fax:
Practice Address - Street 1:4955 VAN NUYS BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1815
Practice Address - Country:US
Practice Address - Phone:855-838-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical