Provider Demographics
NPI:1063234029
Name:RADERMAN, ABIGAIL SHAY
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:SHAY
Last Name:RADERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14339 GREENLEAF ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4013
Mailing Address - Country:US
Mailing Address - Phone:818-523-3179
Mailing Address - Fax:
Practice Address - Street 1:14339 GREENLEAF ST
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-4013
Practice Address - Country:US
Practice Address - Phone:818-523-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst