Healthcare Provider Details

I. General information

NPI: 1700987930
Provider Name (Legal Business Name): DALE SANFORD SHERMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S SAN VICENTE BLVD STE 256
LOS ANGELES CA
90048-4884
US

IV. Provider business mailing address

640 S SAN VICENTE BLVD STE 256
LOS ANGELES CA
90048-4884
US

V. Phone/Fax

Practice location:
  • Phone: 323-839-7231
  • Fax:
Mailing address:
  • Phone: 323-839-7231
  • Fax: 866-889-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY16377
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: