Provider Demographics
NPI:1558573055
Name:ESTAFANOUS, NADIA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:NADIA
Middle Name:
Last Name:ESTAFANOUS
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 1:2230 CIELO PLACE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006
Mailing Address - Country:US
Mailing Address - Phone:626-355-5337
Mailing Address - Fax:562-868-5452
Practice Address - Street 1:512 EAST WILSON AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206
Practice Address - Country:US
Practice Address - Phone:626-355-5337
Practice Address - Fax:562-868-5454
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44042106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist