Healthcare Provider Details

I. General information

NPI: 1023140001
Provider Name (Legal Business Name): KAREN CHICCA ENYEDY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KAREN ELISE CHICCA

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6455 COLDWATER CANYON AVE
VALLEY GLEN CA
91606-1112
US

IV. Provider business mailing address

6455 COLDWATER CANYON AVE
VALLEY GLEN CA
91606-1112
US

V. Phone/Fax

Practice location:
  • Phone: 818-779-5256
  • Fax: 818-988-2392
Mailing address:
  • Phone: 818-779-5256
  • Fax: 818-988-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: