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NPI Code Detail

MEDICARE: ELEANOR AVIZOF MA MFT

MEDICARE:   ELEANOR  AVIZOF  MA MFT
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
1106H00000XMarriage & Family TherapistIMF79362CA

General Provider Information

NPI Number : 1205227162
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELEANOR AVIZOF MA MFT
Provider Business Mailing Address
First Line : 6320 CANOGA AVE FL 15
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-2563
Country : US
Telephone Number : 818-804-0322
Fax Number :
Provider Business Practice Location Address
First Line : 6320 CANOGA AVE FL 15
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-2563
Country : US
Telephone Number : 818-804-0322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2015
Last Update Date : 02/13/2015

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Directions to “ ELEANOR AVIZOF MA MFT” Practice Location

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