Basic Information
| Provider Information | |||||||||
| NPI: | 1669972949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIBMAN | ||||||||
| FirstName: | YEVGENIYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11044 ACAMA ST UNIT 311 | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916023096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238412348 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15339 SATICOY ST | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914063345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182672619 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2018 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 102452 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 119940 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.