Provider Demographics
NPI:1164961272
Name:MILBERG, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MILBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:
Other - Last Name:MILBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5847 JAMIESON AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1017
Mailing Address - Country:US
Mailing Address - Phone:818-439-1010
Mailing Address - Fax:
Practice Address - Street 1:5847 JAMIESON AVE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1017
Practice Address - Country:US
Practice Address - Phone:818-439-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 94709106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist