Healthcare Provider Details

I. General information

NPI: 1467490987
Provider Name (Legal Business Name): PATRICIA K MASUDA-STORY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA KEIKO MASUDA-STORY PSY.D.

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BRAND BLVD SUITE 316
GLENDALE CA
91203-2641
US

IV. Provider business mailing address

17328 VENTURA BLVD #134
ENCINO CA
91316-3904
US

V. Phone/Fax

Practice location:
  • Phone: 818-561-0531
  • Fax: 800-976-0803
Mailing address:
  • Phone: 818-561-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20385
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY2973
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY20385
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY20385
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY 20385
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY 20385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: