Provider Demographics
NPI:1629648571
Name:PRIMA MATERIA MARRIAGE AND FAMILY THERAPY A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PRIMA MATERIA MARRIAGE AND FAMILY THERAPY A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SASCHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDHOR
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:818-738-3334
Mailing Address - Street 1:507 N BLANCHE ST
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2581
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:790 E SANTA CLARA ST STE 101C
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2965
Practice Address - Country:US
Practice Address - Phone:818-738-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty