NPIMap

Organization Active NPI

Silver Lake Psychology Inc.

  • Psychologist
  • Los Angeles, CA
National Provider Identifier
1932651817
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
22512 Issued in CA
Legal business name
SILVER LAKE PSYCHOLOGY INC.
Practice address
4325 W Sunset Blvd
206
Los Angeles, CA 90029-2174
Phone
(310) 388-7983
NPI assigned
Oct 26, 2016
Last updated
Oct 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Authorized official

Name
Brandy Dunn, PSYDNPI 1073713319
Title
Ceo
Phone
(310) 388-7983

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
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 22512 CA Primary

Addresses

Primary practice location

4325 W Sunset Blvd
206
Los Angeles, CA 90029-2174

Mailing address

4325 W Sunset Blvd
206
Los Angeles, CA 90029-2174
Phone (310) 388-7983

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190524000695 CA Part B Supplier - Clinic/Group Practice 7012250582 Receives reassigned benefits from 105 practitioners
Practice locations: Los Angeles, CA
O20251025000289 VA Part B Supplier - Clinic/Group Practice 7012250582 Receives reassigned benefits from 1 practitioner
Practice locations: Virginia Beach, VA

National Provider Directory

National Provider Directory

Locations

2301 Hyperion Ave
#A
Los Angeles, CA 90027
Phone (310) 726-3890

Practitioners & affiliated clinicians

Practitioners 134

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 134

NPI Registry JSON

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

{
    "created_epoch": "1477440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1932651817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4325 W SUNSET BLVD",
            "address_2": "206",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900292174",
            "telephone_number": "310-388-7983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4325 W SUNSET BLVD",
            "address_2": "206",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900292174",
            "telephone_number": "310-388-7983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVER LAKE PSYCHOLOGY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-26",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "DUNN",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-388-7983",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "CA",
            "license": "22512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; 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.