MEDICARE: DR. PATRICIA K MASUDA-STORY PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY20385	CA
2	103TC0700X	Clinical Psychologist	PSY2973	CO
3	103TF0200X	Forensic Psychologist	PSY20385	CA
4	103TB0200X	Cognitive & Behavioral Psychologist	PSY20385	CA
5	103TP2701X	Group Psychotherapy Psychologist	PSY 20385	CA
6	103TF0000X	Family Psychologist	PSY 20385	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2287027	OTHER	CA	CIGNA
2	12006	OTHER	CA	COLLEGE HEALTH IPA
3	0PL203850	OTHER	CA	BLUE SHIELD
4	2191850	OTHER	CA	COMPSYCH
5	9357265	OTHER	CA	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467490987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA K MASUDA-STORY PSY.D.

Provider Business Mailing Address
First Line	:	17328 VENTURA BLVD
Second Line	:	#134
City	:	ENCINO
State	:	CA
Zip	:	91316-3904
Country	:	US
Telephone Number	:	818-561-0531
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N BRAND BLVD
Second Line	:	SUITE 316
City	:	GLENDALE
State	:	CA
Zip	:	91203-2641
Country	:	US
Telephone Number	:	818-561-0531
Fax Number	:	800-976-0803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	09/03/2016

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