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General NPI Number Information
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NPI Number | 1114438371
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Entity Type | Individual
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Provider Name | DAWN CRUGNALE EBNER LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 11239 TAMPA AVE STE 206
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City | NORTHRIDGE
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State | CA
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Zip | 91326-3781
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Country | US
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Telephone | 805-273-1820
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Fax |
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Provider Business Mailing Address
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Address Line | 455 VIA DE LA LUZ
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City | NEWBURY PARK
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State | CA
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Zip | 91320-6929
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Country | US
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Telephone | 805-368-5397
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 121359
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License Number State | CA
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