Healthcare Provider Details

I. General information

NPI: 1396534889
Provider Name (Legal Business Name): MEGAN L PLOTKOWSKI MA, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N KENTER AVE
LOS ANGELES CA
90049-1316
US

IV. Provider business mailing address

1100 N KENTER AVE
LOS ANGELES CA
90049-1316
US

V. Phone/Fax

Practice location:
  • Phone: 310-497-2576
  • Fax:
Mailing address:
  • Phone: 310-497-2576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT144096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: