Individual provider Active NPI

Dylan Galen Harwood, PH.D.

  • Clinical Neuropsychologist
  • Los Angeles, CA
National Provider Identifier
1245337039
Registry record updated May 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PSY17667 Issued in CA
Practice address
11835 W Olympic Blvd Ste 1265E
Los Angeles, CA 90064
Phone
(310) 273-4843
Fax
(310) 273-5056
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PSY17667 CA Primary

Addresses

Primary practice location

11835 W Olympic Blvd Ste 1265E
Los Angeles, CA 90064

Mailing address

11835 W Olympic Blvd Ste 1265E
Los Angeles, CA 90064-5814
Phone (310) 273-4843

Other identifiers 1

IdentifierTypeStateIssuer
546789MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110826000667 CA Practitioner - Clinical Psychologist 0648440719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
University of Miami, LM Miller School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Executive Mental Health, IncGroup PAC ID 0345209102, 47 clinicians

Practice addresses (Care Compare)

11835 W Olympic Blvd
Suite 1270E
Los Angeles, CA 90064-5053
Phone (310) 273-4843

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY17667CAMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Brian Wu MD PHD Inc CurrentSince Jul 1, 2021 Accepting new patients

Locations

11835 W Olympic Blvd
Ste 1270E
Los Angeles, CA 90064
Phone (310) 273-4843

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527724800000",
    "number": "1245337039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11835 W OLYMPIC BLVD STE 1265E",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900645814",
            "telephone_number": "310-273-4843",
            "fax_number": "310-273-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11835 W OLYMPIC BLVD STE 1265E",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90064",
            "telephone_number": "310-273-4843",
            "fax_number": "310-273-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARWOOD",
        "first_name": "DYLAN",
        "middle_name": "GALEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2018-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY17667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "546789",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.