Provider Demographics
NPI:1710215660
Name:BRAHENY, MARY (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:BRAHENY
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 AVE I
Mailing Address - Street 2:SUITE 16
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5619
Mailing Address - Country:US
Mailing Address - Phone:310-543-2527
Mailing Address - Fax:310-543-2527
Practice Address - Street 1:205 AVE I
Practice Address - Street 2:SUITE 16
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5619
Practice Address - Country:US
Practice Address - Phone:310-543-2527
Practice Address - Fax:310-543-2527
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT27707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist