Provider Demographics
NPI:1205227162
Name:AVIZOF, ELEANOR (MA MFT)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:AVIZOF
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 CANOGA AVE FL 15
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2563
Mailing Address - Country:US
Mailing Address - Phone:818-804-0322
Mailing Address - Fax:
Practice Address - Street 1:6320 CANOGA AVE FL 15
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2563
Practice Address - Country:US
Practice Address - Phone:818-804-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF79362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist