Healthcare Provider Details

I. General information

NPI: 1558664284
Provider Name (Legal Business Name): DANIELLA BEDNARZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10646 ZELZAH AVE STE 207
GRANADA HILLS CA
91344-5959
US

IV. Provider business mailing address

10646 ZELZAH AVE STE 3E207
GRANADA HILLS CA
91344-5947
US

V. Phone/Fax

Practice location:
  • Phone: 818-491-9004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: