Provider Demographics
NPI:1841408952
Name:KIEDMAN, EMILY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:A
Last Name:KIEDMAN
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 1:12311 MIRANDA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1722
Mailing Address - Country:US
Mailing Address - Phone:818-762-8432
Mailing Address - Fax:
Practice Address - Street 1:15409 DICKENS ST
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3009
Practice Address - Country:US
Practice Address - Phone:818-986-4362
Practice Address - Fax:818-986-9263
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18799103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist