Provider Demographics
NPI:1366007122
Name:RASKIN, ESTELLE (LMFT #111146)
Entity Type:Individual
Prefix:
First Name:ESTELLE
Middle Name:
Last Name:RASKIN
Suffix:
Gender:F
Credentials:LMFT #111146
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 N LARCHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3753
Mailing Address - Country:US
Mailing Address - Phone:213-260-1656
Mailing Address - Fax:
Practice Address - Street 1:252 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3753
Practice Address - Country:US
Practice Address - Phone:323-962-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist