Healthcare Provider Details

I. General information

NPI: 1790130300
Provider Name (Legal Business Name): JUDITH VICTOR MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16055 VENTURA BLVD STE 715
ENCINO CA
91436-2610
US

IV. Provider business mailing address

16055 VENTURA BLVD STE 715
ENCINO CA
91436-2610
US

V. Phone/Fax

Practice location:
  • Phone: 323-793-6419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number81537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: