MEDICARE: MS. CANDACE J GESNER MA, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC 45290	CA

General Provider Information

NPI Number	:	1134331697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CANDACE J GESNER MA, LMFT

Provider Business Mailing Address
First Line	:	4470 W SUNSET BLVD
Second Line	:	BOX 280
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6302
Country	:	US
Telephone Number	:	323-229-9517
Fax Number	:	323-660-2342

Provider Business Practice Location Address
First Line	:	4470 W SUNSET BLVD
Second Line	:	BOX 280
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6302
Country	:	US
Telephone Number	:	323-229-9517
Fax Number	:	323-660-2342

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	09/10/2008

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