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NPI Code Detail

MEDICARE: MS. MARA STEPHANIE BRUCKNER M.A., M.F.T.

MEDICARE: MS. MARA STEPHANIE BRUCKNER M.A., M.F.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC36105CA

General Provider Information

NPI Number : 1033239918
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARA STEPHANIE BRUCKNER M.A., M.F.T.
Provider Business Mailing Address
First Line : 22040 VISCANIO RD
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91364-4110
Country : US
Telephone Number : 818-725-7924
Fax Number : 818-713-0923
Provider Business Practice Location Address
First Line : 6340 VARIEL AVE
Second Line : SUITE A
City : WOODLAND HILLS
State : CA
Zip : 91367-2514
Country : US
Telephone Number : 818-725-7924
Fax Number : 818-888-4005
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 07/08/2007

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