MEDICARE: ROBERT L. MENDELSOHN M.F.T.

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	39142	CA

General Provider Information

NPI Number	:	1861630618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT L. MENDELSOHN M.F.T.

Provider Business Mailing Address
First Line	:	179 S BARRINGTON PL
Second Line	:	SUITE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3305
Country	:	US
Telephone Number	:	310-923-6233
Fax Number	:	323-937-3487

Provider Business Practice Location Address
First Line	:	179 S BARRINGTON PL
Second Line	:	SUITE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3305
Country	:	US
Telephone Number	:	310-923-6233
Fax Number	:	323-937-3487

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

Provider Enumeration Date	:	02/02/2009
Last Update Date	:	02/02/2009

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