Provider Demographics
NPI:1669677555
Name:FLAXMAN, GERALDINE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:
Last Name:FLAXMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 30TH ST STE 211
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3025
Mailing Address - Country:US
Mailing Address - Phone:310-452-6693
Mailing Address - Fax:310-455-3074
Practice Address - Street 1:2665 30TH ST STE 211
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3025
Practice Address - Country:US
Practice Address - Phone:310-452-6693
Practice Address - Fax:310-455-3074
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT18856106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist