Healthcare Provider Details

I. General information

NPI: 1902052269
Provider Name (Legal Business Name): MANAR FARE DAHABREH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14515 HAMLIN ST 102
VAN NUYS CA
91411-1608
US

IV. Provider business mailing address

14515 HAMLIN ST 102
VAN NUYS CA
91411-1608
US

V. Phone/Fax

Practice location:
  • Phone: 818-989-7475
  • Fax: 818-908-2434
Mailing address:
  • Phone: 818-989-7475
  • Fax: 818-908-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 91141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: