Provider Demographics
NPI:1821194945
Name:CHERKASKY, SCOTT
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:CHERKASKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 15TH ST
Mailing Address - Street 2:STE. 313
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3007
Mailing Address - Country:US
Mailing Address - Phone:213-742-6407
Mailing Address - Fax:213-748-9353
Practice Address - Street 1:16255 VENTURA BLVD
Practice Address - Street 2:STE. 806
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2302
Practice Address - Country:US
Practice Address - Phone:310-777-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA552112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A552111Medicaid
CA00A552111Medicaid
CAA55211Medicare ID - Type Unspecified