Provider Demographics
NPI:1376890657
Name:BIESMAN, JONINE (PSY,D ABPDN)
Entity Type:Individual
Prefix:DR
First Name:JONINE
Middle Name:
Last Name:BIESMAN
Suffix:
Gender:F
Credentials:PSY,D ABPDN
Other - Prefix:DR
Other - First Name:JONINE
Other - Middle Name:
Other - Last Name:NAZAR-BIESMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15928 VENTURA BLVD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4401
Mailing Address - Country:US
Mailing Address - Phone:818-415-6435
Mailing Address - Fax:
Practice Address - Street 1:15928 VENTURA BLVD
Practice Address - Street 2:SUITE 221
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4401
Practice Address - Country:US
Practice Address - Phone:818-415-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17283103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist