Provider Demographics
NPI:1023276193
Name:ALVY, DIANE (MFT 44005)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:ALVY
Suffix:
Gender:F
Credentials:MFT 44005
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 S BENTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3045
Mailing Address - Country:US
Mailing Address - Phone:323-304-9771
Mailing Address - Fax:310-477-7616
Practice Address - Street 1:9107 WILSHIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5522
Practice Address - Country:US
Practice Address - Phone:323-304-9771
Practice Address - Fax:310-477-7616
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 44005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist