Healthcare Provider Details

I. General information

NPI: 1942617261
Provider Name (Legal Business Name): DEENA MARGOLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 BEVERLY BLVD
LOS ANGELES CA
90057
US

IV. Provider business mailing address

11845 W OLYMPIC BLVD STE 705
LOS ANGELES CA
90064-5027
US

V. Phone/Fax

Practice location:
  • Phone: 213-744-0724
  • Fax:
Mailing address:
  • Phone: 310-367-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: