Healthcare Provider Details

I. General information

NPI: 1639100654
Provider Name (Legal Business Name): MANIA HEKMATI MFT, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11805 MAYFIELD AVE APT 102
LOS ANGELES CA
90049-5748
US

IV. Provider business mailing address

11805 MAYFIELD AVE APT 102
LOS ANGELES CA
90049-5748
US

V. Phone/Fax

Practice location:
  • Phone: 310-487-1357
  • Fax: 855-540-4054
Mailing address:
  • Phone: 310-487-1357
  • Fax: 855-540-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number39373
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: