=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225727282
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RIVKAH CUNIN LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2023
-----------------------------------------------------
Last Update Date | 05/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 627 N LARCHMONT BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90004-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-289-6089
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 128 N MANSFIELD AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90036-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-289-6089
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 137272
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------