Provider Demographics
NPI:1184758930
Name:MAYEDA, BRIAN T (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:MAYEDA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 691478
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-9478
Mailing Address - Country:US
Mailing Address - Phone:310-497-3325
Mailing Address - Fax:
Practice Address - Street 1:3200 MOTOR AVENUE
Practice Address - Street 2:VISTA DEL MAR CHILD AND FAMILY SERVICES
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034
Practice Address - Country:US
Practice Address - Phone:310-836-1223
Practice Address - Fax:310-838-2791
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22663103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical