Provider Demographics
NPI:1346253929
Name:CHERNOFF, MARY ELAINE (MFT)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELAINE
Last Name:CHERNOFF
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5308 CHRISTIAN CT
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4078
Mailing Address - Country:US
Mailing Address - Phone:818-889-6764
Mailing Address - Fax:818-991-4918
Practice Address - Street 1:5923 KANAN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1688
Practice Address - Country:US
Practice Address - Phone:818-889-6764
Practice Address - Fax:818-991-4918
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP 2366103T00000X
CAM11657106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist