MEDICARE: DR. DONNA EMMANUEL PH.D.

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	MFC31611	CA

General Provider Information

NPI Number	:	1710967450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA EMMANUEL PH.D.

Provider Business Mailing Address
First Line	:	14156 MAGNOLIA BLVD
Second Line	:	SUITE 105
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-6410
Country	:	US
Telephone Number	:	818-907-8232
Fax Number	:	818-905-6686

Provider Business Practice Location Address
First Line	:	14156 MAGNOLIA BLVD
Second Line	:	SUITE 105
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-6410
Country	:	US
Telephone Number	:	818-907-8232
Fax Number	:	818-905-6686

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/16/2012

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