Individual provider Active NPI

Lexi Welanetz-Bursin, PSY.D.

  • Psychologist
  • Los Angeles, CA
National Provider Identifier
1760582399
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY16306 Issued in CA
Practice address
11500 W Olympic Blvd Ste 420
Los Angeles, CA 90064-1564
Phone
(310) 479-9798
Fax
(310) 479-9796
NPI assigned
Sep 24, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY16306 CA Primary

Addresses

Primary practice location

11500 W Olympic Blvd Ste 420
Los Angeles, CA 90064-1564

Mailing address

11500 W Olympic Blvd Ste 420
Los Angeles, CA 90064-1564
Phone (310) 479-9798

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
I20040603000586 CA Practitioner - Clinical Psychologist 2668454950 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2625 Townsgate Rd
Suite 330
Thousand Oaks, CA 91361-5749
Phone (424) 279-4240

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Psychological Services Inc. Psychologist CurrentSince Jun 1, 2004 Accepting new patients

Locations

11500 W Olympic Blvd
Ste 420
Los Angeles, CA 90064
Phone (310) 479-9798

11500 W Olympic Blvd
Ste 578
Los Angeles, CA 90064
Phone (310) 231-8905

11645 Wilshire Blvd
Ste 1100
Los Angeles, CA 90025
Phone (310) 477-6000

2625 Townsgate Rd
Ste 330
Westlake Vlg, CA 91361
Phone (818) 272-8260

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760582399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11500 W OLYMPIC BLVD STE 420",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900641564",
            "telephone_number": "310-479-9798",
            "fax_number": "310-479-9796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11500 W OLYMPIC BLVD STE 420",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900641564",
            "telephone_number": "310-479-9798",
            "fax_number": "310-479-9796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELANETZ-BURSIN",
        "first_name": "LEXI",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY16306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.