Provider Demographics
NPI:1699808360
Name:SHABANZADEH, VICTORIA (PHD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SHABANZADEH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:SKOLNIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6931 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6931 VAN NUYS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3937
Practice Address - Country:US
Practice Address - Phone:818-376-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18580103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASTI9129OtherPSYCHOLOGIST