Provider Demographics
NPI:1073654372
Name:DAMIELLS, EMILY JOANNE (MFT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JOANNE
Last Name:DAMIELLS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5675 TELEGRAPH RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1570
Mailing Address - Country:US
Mailing Address - Phone:323-838-9566
Mailing Address - Fax:323-838-9572
Practice Address - Street 1:5675 TELEGRAPH RD
Practice Address - Street 2:STE. 200
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1570
Practice Address - Country:US
Practice Address - Phone:323-838-9566
Practice Address - Fax:323-838-9572
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52791106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist