MEDICARE: DR. CRYSTAL FERRENDELLI PSYD

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	103TC0700X	Clinical Psychologist	32837	CA

General Provider Information

NPI Number	:	1679928196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL FERRENDELLI PSYD

Provider Business Mailing Address
First Line	:	5739 KANAN RD # 500
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1601
Country	:	US
Telephone Number	:	818-661-8317
Fax Number	:

Provider Business Practice Location Address
First Line	:	5739 KANAN RD # 500
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1601
Country	:	US
Telephone Number	:	818-661-8317
Fax Number	:

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

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	05/31/2024

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