MEDICARE: CAROLINE ANTONIA SALZ 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	105615	CA

General Provider Information

NPI Number	:	1164928669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE ANTONIA SALZ MA, LMFT

Provider Business Mailing Address
First Line	:	1295 S COCHRAN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-2846
Country	:	US
Telephone Number	:	646-943-3993
Fax Number	:

Provider Business Practice Location Address
First Line	:	2566 OVERLAND AVE STE 500B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-5600
Country	:	US
Telephone Number	:	310-948-2969
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	04/03/2018

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