Provider Demographics
NPI:1497086920
Name:ROZDIAL, DANIEL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:ROZDIAL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 RORY LN
Mailing Address - Street 2:UNIT 04
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-4366
Mailing Address - Country:US
Mailing Address - Phone:818-676-1540
Mailing Address - Fax:818-676-1542
Practice Address - Street 1:3695 ALAMO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2188
Practice Address - Country:US
Practice Address - Phone:818-676-1540
Practice Address - Fax:818-676-1542
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48037106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist