Provider Demographics
NPI:1154450419
Name:MRAZEK, PAMELA J (MFT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:MRAZEK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1158 26TH ST
Mailing Address - Street 2:785
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4698
Mailing Address - Country:US
Mailing Address - Phone:310-393-5611
Mailing Address - Fax:760-924-2482
Practice Address - Street 1:1000 FREMONT AVE
Practice Address - Street 2:ANNEX BUILDING SUITE G
Practice Address - City:S PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3225
Practice Address - Country:US
Practice Address - Phone:310-393-5611
Practice Address - Fax:760-924-2482
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT24575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist