Provider Demographics
NPI:1508299801
Name:CHERRY, WENDY G (PSYD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:G
Last Name:CHERRY
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 1:1072 KATHERINE RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-4739
Mailing Address - Country:US
Mailing Address - Phone:818-540-8657
Mailing Address - Fax:
Practice Address - Street 1:15639 WOODFIELD PL
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-4236
Practice Address - Country:US
Practice Address - Phone:818-540-8657
Practice Address - Fax:818-990-7070
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-10
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25890103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist