Provider Demographics
NPI:1336279991
Name:LAFRENIERE, MARIE GALE V (MFT)
Entity Type:Individual
Prefix:
First Name:MARIE GALE
Middle Name:V
Last Name:LAFRENIERE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:GALE
Other - Middle Name:V
Other - Last Name:LAFRENIERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 3012
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91394-0012
Mailing Address - Country:US
Mailing Address - Phone:818-356-4327
Mailing Address - Fax:
Practice Address - Street 1:9535 RESEDA BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2310
Practice Address - Country:US
Practice Address - Phone:818-356-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41335106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist