Provider Demographics
NPI:1295031862
Name:FARMANI, MARYAM T
Entity Type:Individual
Prefix:MRS
First Name:MARYAM
Middle Name:T
Last Name:FARMANI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARYAM
Other - Middle Name:T
Other - Last Name:FARMANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:18530 HATTERAS ST UNIT 213
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1914
Mailing Address - Country:US
Mailing Address - Phone:310-569-8328
Mailing Address - Fax:
Practice Address - Street 1:20300 VENTURA BLVD STE 315
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-0903
Practice Address - Country:US
Practice Address - Phone:310-569-8328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46758106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist