Provider Demographics
NPI:1346672706
Name:KERDMAN, SAMANTHA ROBYN (MAED, MA, LMFT)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:ROBYN
Last Name:KERDMAN
Suffix:
Gender:F
Credentials:MAED, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14343 MANGROVE ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3545
Mailing Address - Country:US
Mailing Address - Phone:818-942-4426
Mailing Address - Fax:
Practice Address - Street 1:501 MARIN ST STE 202
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4266
Practice Address - Country:US
Practice Address - Phone:805-494-1414
Practice Address - Fax:805-426-8575
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83016106H00000X
CA105929106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist