Provider Demographics
NPI:1225464449
Name:DR. MAHSA MAURIELLO INC
Entity Type:Organization
Organization Name:DR. MAHSA MAURIELLO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-706-1926
Mailing Address - Street 1:10436 SANTA MONICA BLVD STE 3030
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5079
Mailing Address - Country:US
Mailing Address - Phone:818-706-1926
Mailing Address - Fax:
Practice Address - Street 1:10436 SANTA MONICA BLVD #3030
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:818-706-1926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAHSA MAURIELLO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37690106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty