Robert William Elliott, PSYCHOLOGIST

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY5107 Issued in CA

Practice address

5777 W Century Blvd Ste 1645B
Los Angeles, CA 90045-5696

Phone

(310) 545-6400

Fax

(310) 939-7065

NPI assigned

Jan 16, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364428800000",
    "number": "1689725574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5777 W CENTURY BLVD STE 1645B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455696",
            "telephone_number": "310-545-6400",
            "fax_number": "310-939-7065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5777 W CENTURY BLVD STE 1645B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455696",
            "telephone_number": "310-545-6400",
            "fax_number": "310-939-7065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "ROBERT",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "PSYCHOLOGIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2013-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY5107",
            "primary": true
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "HI",
            "license": "711",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Lynne Elliott
• Joshua Glenn Elliott, M.D.
• Julenne Elliott
• Natasha Chitra Elliott, LCSW
• Paula Michelle Elliott, CATC I - IN PROGRESS
• Terry Elliott, PA-C
• Tiffany Elliott, DDS
• Tiffany Kay Elliott
• Tomas Elliott
• Ellis C. Wong,DDS,Inc.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.