Healthcare Provider Details

I. General information

NPI: 1023973344
Provider Name (Legal Business Name): ROBERTA LEE KIRCHNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22231 MULHOLLAND HWY STE 200
CALABASAS CA
91302-5173
US

IV. Provider business mailing address

578 WASHINGTON BLVD # 637
MARINA DEL REY CA
90292-5421
US

V. Phone/Fax

Practice location:
  • Phone: 310-853-2489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: