Provider Demographics
NPI:1679860530
Name:ITKIN, NATALIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:ITKIN
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 1:22241 ALIZONDO DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-6104
Mailing Address - Country:US
Mailing Address - Phone:310-923-2222
Mailing Address - Fax:
Practice Address - Street 1:22241 ALIZONDO DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-6104
Practice Address - Country:US
Practice Address - Phone:310-923-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34716103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA34716OtherSTATE OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS BOARD OF PSYCHOLOGY