Basic Information
Provider Information
NPI: 1376675579
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SZABO
FirstName: JOSEPH
MiddleName: THOMAS
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1106
Address2:  
City: LA CANADA
State: CA
PostalCode: 910121106
CountryCode: US
TelephoneNumber: 8186218894
FaxNumber:  
Practice Location
Address1: 6305 WOODMAN AVE
Address2:  
City: VAN NUYS
State: CA
PostalCode: 914012346
CountryCode: US
TelephoneNumber: 8189084999
FaxNumber: 8189080123
Other Information
ProviderEnumerationDate: 03/12/2007
LastUpdateDate: 04/17/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000XMFC46604CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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