Provider Demographics
NPI:1003476185
Name:EDELSTEIN, CYNTHIA TL
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:TL
Last Name:EDELSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31716 SADDLETREE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4705
Mailing Address - Country:US
Mailing Address - Phone:805-206-8107
Mailing Address - Fax:
Practice Address - Street 1:30101 AGOURA CT STE 150
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4369
Practice Address - Country:US
Practice Address - Phone:805-433-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist