Provider Demographics
NPI:1689906646
Name:BOCZAN, DEBRA JAN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JAN
Last Name:BOCZAN
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 1:2201 STANLEY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-1531
Mailing Address - Country:US
Mailing Address - Phone:310-666-4913
Mailing Address - Fax:323-650-4356
Practice Address - Street 1:9808 VENICE BLVD STE 401
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6800
Practice Address - Country:US
Practice Address - Phone:310-815-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist