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General NPI Number Information
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NPI Number | 1780051243
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Entity Type | Individual
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Provider Name | ROSE MICHAL AIZENMAN MA LPCC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 08/31/2015
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Provider Practice Location Address
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Address Line | 1314 WESTWOOD BLVD SUIT 206
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City | LOS ANGELES
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State | CA
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Zip | 90024-4928
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Country | US
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Telephone | 831-345-7164
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Fax |
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Provider Business Mailing Address
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Address Line | 11923 DARLINGTON AVE UNIT 401
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City | LOS ANGELES
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State | CA
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Zip | 90049-5670
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Country | US
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Telephone | 831-345-7164
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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 | LPCC1474
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License Number State | CA
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