Provider Demographics
NPI:1679861967
Name:GANS, ROBIN AMY (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:AMY
Last Name:GANS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:A
Other - Last Name:GANS A PSYCHOLOGICAL CORP.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:4257 LEMP AVE
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2812
Mailing Address - Country:US
Mailing Address - Phone:818-358-3378
Mailing Address - Fax:818-358-3379
Practice Address - Street 1:4257 LEMP AVE
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2812
Practice Address - Country:US
Practice Address - Phone:818-358-3378
Practice Address - Fax:818-358-3379
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17365103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist