Provider Demographics
NPI:1760642755
Name:O'TOOLE, MICHAELA (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:O'TOOLE
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 1:14011 VENTURA BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3533
Mailing Address - Country:US
Mailing Address - Phone:818-771-8020
Mailing Address - Fax:818-509-5772
Practice Address - Street 1:14011 VENTURA BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3533
Practice Address - Country:US
Practice Address - Phone:818-771-8020
Practice Address - Fax:818-509-5772
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18104103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent