Provider Demographics
NPI:1982775532
Name:KAGAN, SANDRA SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:SUE
Last Name:KAGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 VENTURA BLVD
Mailing Address - Street 2:641
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2406
Mailing Address - Country:US
Mailing Address - Phone:818-789-7575
Mailing Address - Fax:818-761-4449
Practice Address - Street 1:4821 BEEMAN AVE
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3402
Practice Address - Country:US
Practice Address - Phone:818-789-7575
Practice Address - Fax:818-761-4449
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT067730101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor