Provider Demographics
NPI:1154526390
Name:GANTMAN, SHERI (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHERI
Middle Name:
Last Name:GANTMAN
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 1:18653 VENTURA BLVD
Mailing Address - Street 2:#166
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4103
Mailing Address - Country:US
Mailing Address - Phone:818-344-5057
Mailing Address - Fax:818-344-8383
Practice Address - Street 1:5019 CALVIN AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4419
Practice Address - Country:US
Practice Address - Phone:818-344-5057
Practice Address - Fax:818-344-8383
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24084106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist