Provider Demographics
NPI:1275663064
Name:RIBEIRO, MILENA
Entity Type:Individual
Prefix:
First Name:MILENA
Middle Name:
Last Name:RIBEIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17324 PARTHENIA ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3239
Mailing Address - Country:US
Mailing Address - Phone:818-933-1145
Mailing Address - Fax:888-959-1173
Practice Address - Street 1:8363 RESEDA BLVD
Practice Address - Street 2:#201
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4623
Practice Address - Country:US
Practice Address - Phone:818-933-1145
Practice Address - Fax:888-959-1173
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44442106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist