MEDICARE: ERIC DANIEL KASTAN 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 47461	CA

General Provider Information

NPI Number	:	1700113248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC DANIEL KASTAN LMFT

Provider Business Mailing Address
First Line	:	10642 SANTA MONICA BLVD
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4525
Country	:	US
Telephone Number	:	310-470-9016
Fax Number	:	310-470-3169

Provider Business Practice Location Address
First Line	:	10642 SANTA MONICA BLVD
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4525
Country	:	US
Telephone Number	:	310-470-9016
Fax Number	:	310-470-3169

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

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	11/04/2009

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