Provider Demographics
NPI:1124065206
Name:SELLWOOD, KATHERINE L (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:L
Last Name:SELLWOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:# 977
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-907-5491
Mailing Address - Fax:818-907-5438
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 977
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-907-5491
Practice Address - Fax:818-907-5438
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18136103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP18136CMedicare PIN