MEDICARE: ELLIE JOSEFSON

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 # 47314	CA

General Provider Information

NPI Number	:	1720218761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIE JOSEFSON

Provider Business Mailing Address
First Line	:	17337 TRAMONTO DR
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-3121
Country	:	US
Telephone Number	:	310-721-9886
Fax Number	:	310-573-0345

Provider Business Practice Location Address
First Line	:	520 S SEPULVEDA BLVD STE 406
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3547
Country	:	US
Telephone Number	:	310-721-9886
Fax Number	:	310-472-0333

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

Provider Enumeration Date	:	07/24/2009
Last Update Date	:	06/26/2014

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