Provider Demographics
NPI:1457465312
Name:DUBIN, LORETTA ELAINE (MFT)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:ELAINE
Last Name:DUBIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:DUBIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:18345 VENTURA BLVD
Mailing Address - Street 2:STE 515
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-343-9105
Mailing Address - Fax:310-826-6696
Practice Address - Street 1:18345 VENTURA BLVD
Practice Address - Street 2:STE 515
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-343-9105
Practice Address - Fax:310-826-6696
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT16824106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist