Provider Demographics
NPI:1639100654
Name:HEKMATI, MANIA (MFT, PSYD)
Entity Type:Individual
Prefix:
First Name:MANIA
Middle Name:
Last Name:HEKMATI
Suffix:
Gender:F
Credentials:MFT, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11805 MAYFIELD AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5748
Mailing Address - Country:US
Mailing Address - Phone:310-487-1357
Mailing Address - Fax:855-540-4054
Practice Address - Street 1:11805 MAYFIELD AVE APT 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5748
Practice Address - Country:US
Practice Address - Phone:310-487-1357
Practice Address - Fax:855-540-4054
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39373106H00000X
CAMFC39373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC39373OtherCA LICENCE