Provider Demographics
NPI:1518782036
Name:HAYMOVITZ, ETHAN (DSW)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:
Last Name:HAYMOVITZ
Suffix:
Gender:M
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 W 6TH ST # 101-1116
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-5005
Mailing Address - Country:US
Mailing Address - Phone:213-982-3614
Mailing Address - Fax:
Practice Address - Street 1:617 S OLIVE ST STE 800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-1629
Practice Address - Country:US
Practice Address - Phone:213-982-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA881211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical