Healthcare Provider Details

I. General information

NPI: 1003749730
Provider Name (Legal Business Name): CARISSA DURAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 LAS VIRGENES RD
CALABASAS CA
91302-1929
US

IV. Provider business mailing address

4111 LAS VIRGENES RD
CALABASAS CA
91302-1929
US

V. Phone/Fax

Practice location:
  • Phone: 818-880-4000
  • Fax: 818-880-4000
Mailing address:
  • Phone:
  • Fax: 818-880-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220200644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: