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General NPI Number Information
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NPI Number | 1073902235
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Entity Type | Individual
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Provider Name | MIRJAM AFENI HATTON PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 02/24/2024
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Provider Practice Location Address
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Address Line | 958 VENANGO AVE
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City | LOS ANGELES
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State | CA
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Zip | 90029-3020
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Country | US
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Telephone | 213-537-8565
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27591
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City | LOS ANGELES
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State | CA
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Zip | 90027-0591
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Country | US
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Telephone | 213-537-8565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 98906
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 34098
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License Number State | CA
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