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Individual

CHARLOTTE DISTEFANO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
760 WESTWOOD PLZ # 48-240, LOS ANGELES, CA 90095-8353
(310) 825-0586
Mailing address
760 WESTWOOD PLZ # A7-461, LOS ANGELES, CA 90095-8353
(310) 825-8892

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY29280
CA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PSY29280
CA

Other

Enumeration date
07/17/2017
Last updated
07/17/2017
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