DR. MARYLOUISE NONE BARROS-NISKA, MFCC AND PH.D - NPI NUMBER 1013095629

Summary

Provider Name: DR. MARYLOUISE NONE BARROS-NISKA, MFCC AND PH.D

NPI Number: 1013095629

Clasification: Psychologist (103TC0700X)

Specialization: Clinical

Address:
550 S VERMONT AVE
LOS ANGELES, CA
ZIP 90020

Phone Number: (213) 485-3300



Detailed Information

DR. Marylouise None Barros-niska, MFCC AND PH.D is a clinical psychologist in Los Angeles, CA. The assigned NPI number for this provider is 1013095629 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

550 S VERMONT AVE
LOS ANGELES, CA
ZIP 90020-912
Phone: (213) 485-3300

The enumeration date for this NPI number is 11/1/2006 and was last updated on 7/8/2007.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 103TC0700X Psychologist Clinical PSY17723 CA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 103TC0700X MEDICARE ID-TYPE UNSPECIFIED CA PH.D

NPI Record

No. Field Name Field Value
1 NPI 1013095629
2 Entity Type Code 1
3 Provider Last Name Legal Name BARROS-NISKA
4 Provider First Name MARYLOUISE
5 Provider Middle Name NONE
6 Provider Name Prefix Text DR.
7 Provider Credential Text MFCC AND PH.D
8 Provider First Line Business Practice Location Address 550 S VERMONT AVE
9 Provider Business Practice Location Address City Name LOS ANGELES
10 Provider Business Practice Location Address State Name CA
11 Provider Business Practice Location Address Postal Code 900201912
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 2134853300
14 Provider Enumeration Date 11/1/2006
15 Last Update Date 7/8/2007
16 Provider Gender Code F
17 Healthcare Provider Taxonomy Code 1 103TC0700X
18 Provider License Number 1 PSY17723
19 Provider License Number State Code 1 CA
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Other Provider Identifier 1 103TC0700X
22 Other Provider Identifier Type Code 1 04
23 Other Provider Identifier State 1 CA
24 Other Provider Identifier Issuer 1 PH.D
25 Is Sole Proprietor Y

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This page was last updated on: 11/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.