Provider Demographics
NPI:1225239312
Name:CHUSID, HANNA SHIRA (LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:HANNA
Middle Name:SHIRA
Last Name:CHUSID
Suffix:
Gender:F
Credentials:LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 SALTILLO ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4432
Mailing Address - Country:US
Mailing Address - Phone:818-703-7524
Mailing Address - Fax:
Practice Address - Street 1:4409 SALTILLO ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4432
Practice Address - Country:US
Practice Address - Phone:818-703-7524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12001103TA0700X, 103TB0200X, 103TH0004X, 103TH0100X, 103TP2701X, 103TC0700X
CA42783061701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical