Provider Demographics
NPI:1366672909
Name:RICHMAN, DENISE LAURIE (MS)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:LAURIE
Last Name:RICHMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57614
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-2614
Mailing Address - Country:US
Mailing Address - Phone:818-326-4630
Mailing Address - Fax:
Practice Address - Street 1:11565 LAUREL CANYON BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4168
Practice Address - Country:US
Practice Address - Phone:818-361-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49768106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist