MEDICARE: CANDICE SHERBIN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MFC33479	CA

General Provider Information

NPI Number	:	1578546636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE SHERBIN PSY.D.

Provider Business Mailing Address
First Line	:	15720 VENTURA BLVD
Second Line	:	SUITE 512
City	:	ENCINO
State	:	CA
Zip	:	91436
Country	:	US
Telephone Number	:	818-788-8095
Fax Number	:	818-881-4299

Provider Business Practice Location Address
First Line	:	15720 VENTURA BLVD
Second Line	:	SUITE 512
City	:	ENCINO
State	:	CA
Zip	:	91436-2914
Country	:	US
Telephone Number	:	818-788-8095
Fax Number	:	818-881-4299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/08/2007

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