Provider Demographics
NPI:1467490987
Name:MASUDA-STORY, PATRICIA K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:K
Last Name:MASUDA-STORY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:KEIKO
Other - Last Name:MASUDA-STORY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:17328 VENTURA BLVD
Mailing Address - Street 2:#134
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3904
Mailing Address - Country:US
Mailing Address - Phone:818-561-0531
Mailing Address - Fax:
Practice Address - Street 1:100 N BRAND BLVD
Practice Address - Street 2:SUITE 316
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2641
Practice Address - Country:US
Practice Address - Phone:818-561-0531
Practice Address - Fax:800-976-0803
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20385103TC0700X, 103TF0200X, 103TB0200X
COPSY2973103TC0700X
CAPSY 20385103TP2701X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2287027OtherCIGNA
CA12006OtherCOLLEGE HEALTH IPA
CA0PL203850OtherBLUE SHIELD
CA2191850OtherCOMPSYCH
CA9357265OtherAETNA
CAPSY203850Medicaid
CAWCP20385AMedicare UPIN
CA2191850OtherCOMPSYCH
CA2287027OtherCIGNA