Provider Demographics
NPI:1336503184
Name:RIBAKOFF, DOLORES ROBIN (MFT)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:ROBIN
Last Name:RIBAKOFF
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:RIBAKOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:4145 CAMINO DE LA CUMBRE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4023
Mailing Address - Country:US
Mailing Address - Phone:818-469-5072
Mailing Address - Fax:
Practice Address - Street 1:5535 BALBOA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1553
Practice Address - Country:US
Practice Address - Phone:818-469-5072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT14234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist