Provider Demographics
NPI:1720963044
Name:KOSTMAN, MADELEINE REBECCA (LMFT)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:REBECCA
Last Name:KOSTMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10661 WILKINS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5837
Mailing Address - Country:US
Mailing Address - Phone:310-387-1492
Mailing Address - Fax:
Practice Address - Street 1:10661 WILKINS AVE APT 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5837
Practice Address - Country:US
Practice Address - Phone:310-387-1492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140335106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist