Provider Demographics
NPI:1891085296
Name:WEINGARTEN, ILENE (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:
Last Name:WEINGARTEN
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 1:15720 VENTURA BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2926
Mailing Address - Country:US
Mailing Address - Phone:818-906-0406
Mailing Address - Fax:
Practice Address - Street 1:6399 WILSHIRE BLVD STE 312
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5706
Practice Address - Country:US
Practice Address - Phone:323-651-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist