Provider Demographics
NPI:1609194026
Name:BIROC, JOHN DANIEL (MFT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANIEL
Last Name:BIROC
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16861 VENTURA BLVD
Mailing Address - Street 2:304
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1708
Mailing Address - Country:US
Mailing Address - Phone:818-314-3139
Mailing Address - Fax:818-886-0628
Practice Address - Street 1:16861 VENTURA BLVD
Practice Address - Street 2:304
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1708
Practice Address - Country:US
Practice Address - Phone:818-314-3139
Practice Address - Fax:818-886-0628
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMF16752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist