Provider Demographics
NPI:1942411343
Name:FLEISHMAN, SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:FLEISHMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14724 VENTURA BLVD
Mailing Address - Street 2:SUITE# 1100
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3501
Mailing Address - Country:US
Mailing Address - Phone:310-804-4432
Mailing Address - Fax:
Practice Address - Street 1:430 E AVENIDA DE LOS ARBOLES
Practice Address - Street 2:SUITE# 101
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3003
Practice Address - Country:US
Practice Address - Phone:805-492-5477
Practice Address - Fax:805-492-3057
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18011103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY18011Medicare ID - Type Unspecified
CAP66267Medicare UPIN