Provider Demographics
NPI:1740493766
Name:TAYLOR, CHARLOTTE (PSYD, CRC)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PSYD, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17337 VENTURA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3903
Mailing Address - Country:US
Mailing Address - Phone:818-981-7845
Mailing Address - Fax:818-459-3787
Practice Address - Street 1:17337 VENTURA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3903
Practice Address - Country:US
Practice Address - Phone:818-981-7845
Practice Address - Fax:818-459-3787
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19895103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical