Provider Demographics
NPI:1437559259
Name:BONNIE FELDMAN MFT
Entity Type:Organization
Organization Name:BONNIE FELDMAN MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE & FAMILY THERAPIS
Authorized Official - Prefix:MS
Authorized Official - First Name:BONIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:310-351-3474
Mailing Address - Street 1:1625 N LAUREL AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2519
Mailing Address - Country:US
Mailing Address - Phone:310-351-3474
Mailing Address - Fax:323-965-0444
Practice Address - Street 1:5675 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4712
Practice Address - Country:US
Practice Address - Phone:323-965-1365
Practice Address - Fax:323-965-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45325106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty