MEDICARE: DR. DALE SANFORD SHERMAN PH.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	103TC0700X	Clinical Psychologist	PSY16377	CA
2	103G00000X	Clinical Neuropsychologist	PSY16377	CA

General Provider Information

NPI Number	:	1700987930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE SANFORD SHERMAN PH.D.

Provider Business Mailing Address
First Line	:	640 S SAN VICENTE BLVD STE 256
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4884
Country	:	US
Telephone Number	:	323-839-7231
Fax Number	:	866-889-9292

Provider Business Practice Location Address
First Line	:	640 S SAN VICENTE BLVD STE 256
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4884
Country	:	US
Telephone Number	:	323-839-7231
Fax Number	:

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	06/12/2020

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