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NPI Code Detail

MEDICARE: MS. BEVERLY HANSEN WEISBLATT MA, MFTI

MEDICARE: MS. BEVERLY HANSEN WEISBLATT MA, MFTI
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 Therapist86781CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1147781778OTHERCANPI

General Provider Information

NPI Number : 1477817708
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BEVERLY HANSEN WEISBLATT MA, MFTI
Provider Business Mailing Address
First Line : 6491 IVARENE AVE.
Second Line :
City : LOS ANGELES
State : CA
Zip : 90068
Country : US
Telephone Number : 323-652-2525
Fax Number :
Provider Business Practice Location Address
First Line : 6491 IVARENE AVE.
Second Line :
City : LOS ANGELES
State : CA
Zip : 90068
Country : US
Telephone Number : 323-652-2525
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2012
Last Update Date : 06/02/2015

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