Healthcare Provider Details

I. General information

NPI: 1104315621
Provider Name (Legal Business Name): THE ED ASNER FAMILY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16340 ROSCOE BLVD STE 101
VAN NUYS CA
91406-1217
US

IV. Provider business mailing address

12400 VENTURA BLVD # 371
STUDIO CITY CA
91604-2406
US

V. Phone/Fax

Practice location:
  • Phone: 818-855-2199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISA SADD
Title or Position: DIRECTOR OF MENTAL HEALTH
Credential: LMFT
Phone: 818-855-2199