Healthcare Provider Details

I. General information

NPI: 1336058205
Provider Name (Legal Business Name): KENNETH BLANKSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 LANKERSHIM BLVD STE F
NORTH HOLLYWOOD CA
91601-4572
US

IV. Provider business mailing address

4821 LANKERSHIM BLVD STE F
NORTH HOLLYWOOD CA
91601-4572
US

V. Phone/Fax

Practice location:
  • Phone: 310-734-8351
  • Fax:
Mailing address:
  • Phone: 310-734-8351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT164387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: