Healthcare Provider Details

I. General information

NPI: 1629415450
Provider Name (Legal Business Name): JODY FUTORIAN SALTZMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODY FUTORIAN SALTZMAN PH.D.

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 CHESEBRO RD
AGOURA HILLS CA
91301-2278
US

IV. Provider business mailing address

5014 CHESEBRO RD
AGOURA HILLS CA
91301-2278
US

V. Phone/Fax

Practice location:
  • Phone: 818-707-7366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: