Provider Demographics
NPI:1265859219
Name:MADANI, NANCY R (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:R
Last Name:MADANI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:R
Other - Last Name:MADANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, LMFT
Mailing Address - Street 1:15792 MIDWOOD DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-3234
Mailing Address - Country:US
Mailing Address - Phone:818-900-3231
Mailing Address - Fax:818-825-5342
Practice Address - Street 1:2550 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3406
Practice Address - Country:US
Practice Address - Phone:626-744-5230
Practice Address - Fax:626-744-5242
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT139381106H00000X
CAIMFT78976101YM0800X
CAAMFT117232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265859219OtherMEDICAL