Healthcare Provider Details

I. General information

NPI: 1013837822
Provider Name (Legal Business Name): ISABEL SARAH MADDAHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 SAN VICENTE BLVD
SANTA MONICA CA
90402-2104
US

IV. Provider business mailing address

1220 SAN VICENTE BLVD
SANTA MONICA CA
90402-2104
US

V. Phone/Fax

Practice location:
  • Phone: 310-994-8424
  • Fax:
Mailing address:
  • Phone: 310-994-8424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT163409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: