Provider Demographics
NPI:1285065011
Name:DASHEVSKY-KERDMAN, IRINA (PHD)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:DASHEVSKY-KERDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 STATE ST STE 411
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-5552
Mailing Address - Country:US
Mailing Address - Phone:805-404-1226
Mailing Address - Fax:
Practice Address - Street 1:735 STATE ST STE 411
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-5552
Practice Address - Country:US
Practice Address - Phone:805-404-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty