Provider Demographics
NPI:1790495810
Name:FEDER, KAREN (MA, AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FEDER
Suffix:
Gender:F
Credentials:MA, AMFT, APCC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:BARDAVID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, AMFT, APCC
Mailing Address - Street 1:4924 BALBOA BLVD # 140
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3402
Mailing Address - Country:US
Mailing Address - Phone:818-324-4613
Mailing Address - Fax:
Practice Address - Street 1:5308 DERRY AVE STE J
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4527
Practice Address - Country:US
Practice Address - Phone:747-222-7923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist