Provider Demographics
NPI:1659046084
Name:SERZHAN, ANTON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANTON
Middle Name:
Last Name:SERZHAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4338 GENTRY AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1764
Mailing Address - Country:US
Mailing Address - Phone:818-509-6737
Mailing Address - Fax:
Practice Address - Street 1:4338 GENTRY AVE APT 3
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1764
Practice Address - Country:US
Practice Address - Phone:818-509-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33927103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY33927OtherCALIFORNIA BOARD OF PSYCHOLOGY