Provider Demographics
NPI:1265984215
Name:MANSFIELD, MEGAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 WILSHIRE BLVD STE 520
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5727
Mailing Address - Country:US
Mailing Address - Phone:424-278-4225
Mailing Address - Fax:
Practice Address - Street 1:6363 WILSHIRE BLVD STE 520
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5727
Practice Address - Country:US
Practice Address - Phone:424-278-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2021-06-08
Deactivation Date:2020-01-14
Deactivation Code:
Reactivation Date:2020-01-24
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY31497103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01536011OtherMEDI-CAL