Healthcare Provider Details

I. General information

NPI: 1689311268
Provider Name (Legal Business Name): SAMANTHA HARBERT GELFAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 04/17/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 OCEAN PARK BLVD STE 210
SANTA MONICA CA
90405-3230
US

IV. Provider business mailing address

3301 OCEAN PARK BLVD STE 210
SANTA MONICA CA
90405-3230
US

V. Phone/Fax

Practice location:
  • Phone: 424-354-3650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number132735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: