Provider Demographics
NPI:1760644959
Name:TARGUM, STEVEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:TARGUM
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 1:5535 BALBOA BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1516
Mailing Address - Country:US
Mailing Address - Phone:818-788-8677
Mailing Address - Fax:818-705-6234
Practice Address - Street 1:5535 BALBOA BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1516
Practice Address - Country:US
Practice Address - Phone:818-788-8677
Practice Address - Fax:818-705-6234
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9610103TC0700X
CAMFC17125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist