Provider Demographics
NPI:1851424345
Name:D'AGOSTIN, MICHAEL UDO (PSYD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:UDO
Last Name:D'AGOSTIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
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Mailing Address - Street 1:13244 CUMPSTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6008
Mailing Address - Country:US
Mailing Address - Phone:818-997-8039
Mailing Address - Fax:818-376-1077
Practice Address - Street 1:18646 OXNARD ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1411
Practice Address - Country:US
Practice Address - Phone:818-654-3845
Practice Address - Fax:818-345-6402
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA3555189101YA0400X
CAPSY24187103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)