Provider Demographics
NPI:1275930471
Name:BRUNSTEN, DEBRA (MFT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:BRUNSTEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:R
Other - Last Name:BRUNSTEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:1929 GRANVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1805
Mailing Address - Country:US
Mailing Address - Phone:310-478-0253
Mailing Address - Fax:
Practice Address - Street 1:1929 GRANVILLE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1805
Practice Address - Country:US
Practice Address - Phone:310-478-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34322106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist