Provider Demographics
NPI:1487137295
Name:SUCHOV, REBECCA (PSYD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:SUCHOV
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 VENICE BLVD PH 507
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3534
Mailing Address - Country:US
Mailing Address - Phone:818-571-7008
Mailing Address - Fax:
Practice Address - Street 1:3415 S SEPULVEDA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6060
Practice Address - Country:US
Practice Address - Phone:310-421-9917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY34024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherMEDICAL