Provider Demographics
NPI:1326278268
Name:SHAYNE-MANDLER, SUZANNE (LMFT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SHAYNE-MANDLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16012 MOORPARK ST
Mailing Address - Street 2:UNIT # 303
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1459
Mailing Address - Country:US
Mailing Address - Phone:818-517-6956
Mailing Address - Fax:
Practice Address - Street 1:16012 MOORPARK ST
Practice Address - Street 2:UNIT # 303
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1459
Practice Address - Country:US
Practice Address - Phone:818-517-6956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 28093106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist