Provider Demographics
NPI:1821007089
Name:BALADERIAN, NORA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:J
Last Name:BALADERIAN
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 1:2001 S BARRINGTON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5385
Mailing Address - Country:US
Mailing Address - Phone:310-473-6768
Mailing Address - Fax:310-754-2388
Practice Address - Street 1:2001 S BARRINGTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5385
Practice Address - Country:US
Practice Address - Phone:310-473-6768
Practice Address - Fax:310-754-2388
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11675103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP11675Medicare ID - Type Unspecified
CAR27437Medicare UPIN