Provider Demographics
NPI:1881733988
Name:DAMON, WILLIAM DAVID (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:DAMON
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 1:3109 W 6TH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1700
Mailing Address - Country:US
Mailing Address - Phone:213-590-8921
Mailing Address - Fax:213-738-5368
Practice Address - Street 1:1214 E COLORADO BLVD STE 206
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1899
Practice Address - Country:US
Practice Address - Phone:213-590-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19527103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical