Provider Demographics
NPI:1477747640
Name:BUKOFSKY, MARI SHONE (MFT)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:SHONE
Last Name:BUKOFSKY
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 1:16463 BOSQUE DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3719
Mailing Address - Country:US
Mailing Address - Phone:818-990-3292
Mailing Address - Fax:
Practice Address - Street 1:4419 COLDWATER CANYON AVE
Practice Address - Street 2:SUITE J
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1458
Practice Address - Country:US
Practice Address - Phone:818-990-3292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMI 24290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist