Provider Demographics
NPI:1629415450
Name:SALTZMAN, JODY FUTORIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:FUTORIAN
Last Name:SALTZMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JODY
Other - Middle Name:FUTORIAN
Other - Last Name:SALTZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5014 CHESEBRO RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5014 CHESEBRO RD
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2278
Practice Address - Country:US
Practice Address - Phone:818-707-7366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical