Provider Demographics
NPI:1629277355
Name:SHULMAN, DIANA W (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:W
Last Name:SHULMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 WESTWOOD BLVD
Mailing Address - Street 2:SUITE #208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4954
Mailing Address - Country:US
Mailing Address - Phone:310-474-4053
Mailing Address - Fax:
Practice Address - Street 1:1416 WESTWOOD BLVD
Practice Address - Street 2:SUITE #208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4954
Practice Address - Country:US
Practice Address - Phone:310-474-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARP #41102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst