Provider Demographics
NPI:1457629016
Name:DORE, CATHY ANN (MFT)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:ANN
Last Name:DORE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11712 MOORPARK ST
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2154
Mailing Address - Country:US
Mailing Address - Phone:818-207-0426
Mailing Address - Fax:818-506-7396
Practice Address - Street 1:11712 MOORPARK ST
Practice Address - Street 2:SUITE 110A
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2154
Practice Address - Country:US
Practice Address - Phone:818-207-0426
Practice Address - Fax:818-506-7396
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50155106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist