MEDICARE: DENISS HERNANDEZ CANTOR LMFT 117208

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	95709	CA
2	106H00000X	Marriage & Family Therapist	117208	CA

General Provider Information

NPI Number	:	1700337821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISS HERNANDEZ CANTOR LMFT 117208

Provider Business Mailing Address
First Line	:	4000 W MAGNOLIA BLVD STE A
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2827
Country	:	US
Telephone Number	:	626-604-0802
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 W MAGNOLIA BLVD STE A
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2827
Country	:	US
Telephone Number	:	626-604-0802
Fax Number	:

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

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	06/10/2020

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