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General NPI Number Information
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NPI Number | 1003189135
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Entity Type | Organization
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Legal Business Name | EDELMAN MEDIA
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 5743 CORSA AVE 223
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-4027
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Country | US
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Telephone | 818-635-5191
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Fax |
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Provider Business Mailing Address
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Address Line | 2060-D E AVENIDA DE LOS ARBOLES # 337
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-1376
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Country | US
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Telephone | 818-635-5191
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | MRS. MARINA EDELMAN
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Credential | MFC
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Telephone | 818-635-5191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFC51009
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License Number State | CA
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