Provider Demographics
NPI:1376919480
Name:CHANG PTASINSKI, SANDRA (PHD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CHANG PTASINSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:TERESITA
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:695 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1349
Mailing Address - Country:US
Mailing Address - Phone:213-251-6815
Mailing Address - Fax:213-252-8747
Practice Address - Street 1:695 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1349
Practice Address - Country:US
Practice Address - Phone:213-251-6815
Practice Address - Fax:213-252-8747
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17763103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling