Provider Demographics
NPI:1598781767
Name:DESANNOY, MARGARET WALLACE (MFT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:WALLACE
Last Name:DESANNOY
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 1:9000 VANALDEN AVE
Mailing Address - Street 2:# 120
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3759
Mailing Address - Country:US
Mailing Address - Phone:818-642-5156
Mailing Address - Fax:
Practice Address - Street 1:16858 CLARK ST
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1066
Practice Address - Country:US
Practice Address - Phone:818-817-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 29942106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist