Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY13156 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY13156 | CA |
N | 103TF0200X | Forensic Psychologist | PSY 13156 | CA |
N | 103TH0004X | Health Psychologist | PSY 13156 | CA |
NPI | 1487895736 |
---|---|
Provider Name | Dr. Adam Chidekel |
First Address | Tarzana, CA 91356-4228 |
Second Address | Tarzana, CA 91356-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2009 |
Last Update Date | 17/03/2009 |