Individual
KIRSTY E BORTNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1301 20TH ST STE 150, SANTA MONICA, CA 90404-2050
(310) 458-2764
Mailing address
PO BOX 1493, SIERRA MADRE, CA 91025-4493
(212) 305-3247
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
32126
CA
103TC0700X
Clinical Psychologist
019916
NY
103TC0700X
Clinical Psychologist
32126
CA
Other
Enumeration date
06/15/2007
Last updated
01/09/2024
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