Provider Demographics
NPI:1114124286
Name:SEAN PAKDAMAN PHD A PROFESSIONAL PSYCHOLOGY INC
Entity Type:Organization
Organization Name:SEAN PAKDAMAN PHD A PROFESSIONAL PSYCHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAKDAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,PSYD
Authorized Official - Phone:818-817-8737
Mailing Address - Street 1:5535 BALBOA BLVD
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1516
Mailing Address - Country:US
Mailing Address - Phone:818-817-8737
Mailing Address - Fax:818-817-8738
Practice Address - Street 1:5535 BALBOA BLVD
Practice Address - Street 2:SUITE # 200
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1516
Practice Address - Country:US
Practice Address - Phone:818-817-8737
Practice Address - Fax:818-817-8738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17120Medicare PIN