Provider Demographics
NPI:1770794588
Name:MAGID, ELIZA (MFT)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:MAGID
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 VENTURA BLVD STE 960
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4385
Mailing Address - Country:US
Mailing Address - Phone:310-770-3541
Mailing Address - Fax:818-990-3156
Practice Address - Street 1:16311 VENTURA BLVD STE 960
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4385
Practice Address - Country:US
Practice Address - Phone:310-770-3541
Practice Address - Fax:818-990-3156
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41445106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist