Provider Demographics
NPI:1346088390
Name:HSU, NERRISSA K (RADT-1)
Entity type:Individual
Prefix:MS
First Name:NERRISSA
Middle Name:K
Last Name:HSU
Suffix:
Gender:F
Credentials:RADT-1
Other - Prefix:
Other - First Name:NERRISSA
Other - Middle Name:K
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15152 FRIAR ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1913
Mailing Address - Country:US
Mailing Address - Phone:310-218-8203
Mailing Address - Fax:
Practice Address - Street 1:15152 FRIAR ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1913
Practice Address - Country:US
Practice Address - Phone:310-218-8203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1358640819106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician