Mitzen Black, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

30574 Issued in CA

Practice address

1625 Schrader Blvd
Los Angeles, CA 90028-6213

Phone

(323) 993-7500

NPI assigned

Nov 15, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Los Angeles LGBT Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1548298532
  Medicare reassignment NPD
• Los Angeles LGBT Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1225599178
  NPD
• Los Angeles LGBT Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1023937588
  NPD (past)
• Los Angeles LGBT Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1467057166
  NPD (past)
• Los Angeles LGBT Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1508785056
  NPD (past)

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1467633735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 SCHRADER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900286213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SCHRADER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900286213",
            "telephone_number": "323-993-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "769 N Orange Grove Blvd",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "CA",
            "postal_code": "911033331",
            "country_code": "US",
            "telephone_number": "818-386-1209",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6627 Valjean Ave",
            "address_purpose": "LOCATION",
            "city": "Van Nuys",
            "state": "CA",
            "postal_code": "914065817",
            "country_code": "US",
            "telephone_number": "818-386-1209",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MITZEN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-15",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "30574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Tillman Black Jr., DDS
• Jeanette Marie Black, M.D.
• Jennifer Black, LAC
• Katherine Thomas Black, LCSW
• Keith William Black
• Neda R Black, M.D.
• Ronnesha Unique Black
• Tahje Milan Black
• Blackburn Clinical Services, LLC
• Allie Kieran Blackburn, M.D.

• Clinical Psychologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.