Provider Demographics
NPI:1174745756
Name:KIESEL, DANA (PHD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:KIESEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:CARYL
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:626 N SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3522
Mailing Address - Country:US
Mailing Address - Phone:310-273-8537
Mailing Address - Fax:310-273-7556
Practice Address - Street 1:435 N BEDFORD DR STE 311
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4347
Practice Address - Country:US
Practice Address - Phone:310-273-8537
Practice Address - Fax:310-273-7556
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12664103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12664Medicare ID - Type Unspecified