Provider Demographics
NPI:1629120027
Name:LEIPZIG, CARMELLA (RNC, MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:CARMELLA
Middle Name:
Last Name:LEIPZIG
Suffix:
Gender:F
Credentials:RNC, MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8125 CANBY AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-7523
Mailing Address - Country:US
Mailing Address - Phone:818-885-7234
Mailing Address - Fax:
Practice Address - Street 1:17337 VENTURA BLVD STE 206
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4926
Practice Address - Country:US
Practice Address - Phone:818-995-4477
Practice Address - Fax:818-995-4171
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 30592106H00000X
CARN 327213163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health