Provider Demographics
NPI:1598307803
Name:BRUMAGIN, MOLLY (MA, MFT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BRUMAGIN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4011
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90264-4011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28990 PCH
Practice Address - Street 2:STE 220
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-2927
Practice Address - Country:US
Practice Address - Phone:310-456-3969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist