Provider Demographics
NPI:1609037688
Name:PALOMERA, VANESSA (MA, MFT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:PALOMERA
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 1:14016 BORA BORA WAY
Mailing Address - Street 2:APT 229
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6816
Mailing Address - Country:US
Mailing Address - Phone:980-288-8373
Mailing Address - Fax:
Practice Address - Street 1:13101 W WASHINGTON BLVD
Practice Address - Street 2:#230
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5131
Practice Address - Country:US
Practice Address - Phone:980-288-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85480106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist