Provider Demographics
NPI:1346562006
Name:SESE, CRISTALLE Y (PSYD)
Entity Type:Individual
Prefix:
First Name:CRISTALLE
Middle Name:Y
Last Name:SESE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 W 7TH ST
Mailing Address - Street 2:STE. 650
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-2577
Mailing Address - Country:US
Mailing Address - Phone:323-863-5830
Mailing Address - Fax:
Practice Address - Street 1:1055 W 7TH ST
Practice Address - Street 2:STE 650
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2577
Practice Address - Country:US
Practice Address - Phone:323-863-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23296103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist