Provider Demographics
NPI:1871941716
Name:TINY STEPS DEVELOPMENTAL SERVICES, A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:TINY STEPS DEVELOPMENTAL SERVICES, A PSYCHOLOGICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NEDA
Authorized Official - Middle Name:SAFVATI
Authorized Official - Last Name:WEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:424-209-7787
Mailing Address - Street 1:12522 MOORPARK ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1355
Mailing Address - Country:US
Mailing Address - Phone:424-209-7787
Mailing Address - Fax:818-760-8832
Practice Address - Street 1:12626 RIVERSIDE DR
Practice Address - Street 2:SUITE 303
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3420
Practice Address - Country:US
Practice Address - Phone:424-209-7787
Practice Address - Fax:818-760-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25346103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty