NPIMap

Organization Active NPI

Walter Brown, PH.D., a Psychological Corporation

  • Clinical Psychologist
  • Culver City, CA
National Provider Identifier
1154646271
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY19358 Issued in CA
Legal business name
WALTER BROWN, PH.D., A PSYCHOLOGICAL CORPORATION
Practice address
5800 Hannum Ave.
Suite 100
Culver City, CA 90230-6553
Phone
(310) 410-9504
Fax
(310) 410-9507
NPI assigned
Mar 31, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Walter Brown, PHDNPI 1477658680
Title
President and Owner
Phone
(310) 410-9504

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PSY19358 CA Primary

Addresses

Primary practice location

5800 Hannum Ave.
Suite 100
Culver City, CA 90230-6553

Mailing address

5800 Hannum Ave.
Suite 100
Culver City, CA 90230-6553
Phone (310) 410-9504

Other practice location 1

1000 Lakes Dr Ste 160
West Covina, CA 91790-2928
Phone (310) 410-9504

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110708000483 CA Part B Supplier - Clinic/Group Practice 1658559984 Receives reassigned benefits from 1 practitioner
Practice locations: Culver City, CA

National Provider Directory

National Provider Directory

Locations

5800 Hannum Ave
Ste 100
Culver City, CA 90230
Phone (310) 410-9504

5800 Hannum Ave
Ste 105
Culver City, CA 90230
Phone (310) 410-9504

5839 Green Valley Cir
Ste 100
Culver City, CA 90230
Phone (310) 410-9504

5701 W Slauson Ave
Ste 108
Culver City, CA 90230
Phone (310) 410-9504

1000 Lakes Dr
Ste 160
West Covina, CA 91790
Phone (310) 410-9504

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1269993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701734400000",
    "number": "1154646271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 HANNUM AVE.",
            "address_2": "SUITE 100",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902306553",
            "telephone_number": "310-410-9504",
            "fax_number": "310-410-9507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 HANNUM AVE.",
            "address_2": "SUITE 100",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902306553",
            "telephone_number": "310-410-9504",
            "fax_number": "310-410-9507"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Lakes Dr Ste 160",
            "address_purpose": "LOCATION",
            "city": "West Covina",
            "state": "CA",
            "postal_code": "917902928",
            "country_code": "US",
            "telephone_number": "310-410-9504",
            "fax_number": "310-410-9507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WALTER BROWN, PH.D., A PSYCHOLOGICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-31",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "PRESIDENT AND OWNER",
        "authorized_official_telephone_number": "310-410-9504",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY19358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Culver City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.