Provider Demographics
NPI:1457481772
Name:ALCANTAR, VICTOR (MFT LICENSE)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:ALCANTAR
Suffix:
Gender:M
Credentials:MFT LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18620 HATTERAS ST
Mailing Address - Street 2:162
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1832
Mailing Address - Country:US
Mailing Address - Phone:818-469-7333
Mailing Address - Fax:
Practice Address - Street 1:18620 HATTERAS ST
Practice Address - Street 2:162
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1832
Practice Address - Country:US
Practice Address - Phone:818-469-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist