Provider Demographics
NPI:1235507997
Name:RYDZEWSKI, KATRINA (PSYD)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:RYDZEWSKI
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 1:1990 WESTWOOD BLVD.
Mailing Address - Street 2:SUITE 360
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:248-755-0621
Mailing Address - Fax:801-582-5540
Practice Address - Street 1:1990 WESTWOOD BLVD.
Practice Address - Street 2:SUITE 360
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:248-755-0621
Practice Address - Fax:801-582-5540
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY30831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist