=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013084474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARLENE KASSEL JOSEPHS MAMFCC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11500 OLYMPIC BLVD. 580
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-235-9990
-----------------------------------------------------
Fax | 310-478-1101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11500 OLYMPIC BLVD. 580
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-235-9990
-----------------------------------------------------
Fax | 310-478-1101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER FAMILY THERAPIST PSYCHOTHER
-----------------------------------------------------
Name | MARLENE KASSEL JOSEPHS
-----------------------------------------------------
Credential | MFT
-----------------------------------------------------
Telephone | 310-235-9990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC 32533
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------