Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY 16826 | CA |
N | 103T00000X | Psychologist | PSY 16826 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103G00000X | Clinical Psychologist | PSY 16826 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 16826 | CA |
NPI | 1598804783 |
---|---|
Provider Name | Dr. Rene Dj Hollander |
First Address | Marina Del Rey, CA 90292-5421 |
Second Address | Los Angeles, CA 90066-2618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 02/11/2010 |