Basic Information
| Provider Information | |||||||||
| NPI: | 1336610260 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KAREN S. MAKOFF PHD, CLINICAL PSYCHOLOGIST, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12304 SANTA MONICA BLVD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900252551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106165050 | ||||||||
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| Address1: | 12304 SANTA MONICA BLVD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900252551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106165050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2018 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | MAKOFF | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | SHAWN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3106165050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.