Provider Demographics
NPI:1275831190
Name:LOREN, BRACHA
Entity Type:Individual
Prefix:
First Name:BRACHA
Middle Name:
Last Name:LOREN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BRACHA
Other - Middle Name:
Other - Last Name:LOREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:4419 VAN NUYS BLVD
Mailing Address - Street 2:SUITS # 400
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2910
Mailing Address - Country:US
Mailing Address - Phone:818-344-7000
Mailing Address - Fax:
Practice Address - Street 1:4419 VAN NUYS BLVD
Practice Address - Street 2:SUITE # 400
Practice Address - City:SHERMA OAKS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-344-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 37366106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist