Provider Demographics
NPI:1821454240
Name:BATTISTA, AMADA (BA,IMFT)
Entity type:Individual
Prefix:
First Name:AMADA
Middle Name:
Last Name:BATTISTA
Suffix:
Gender:F
Credentials:BA,IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 WILSHIRE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4659
Mailing Address - Country:US
Mailing Address - Phone:310-402-0005
Mailing Address - Fax:
Practice Address - Street 1:2530 WILSHIRE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4659
Practice Address - Country:US
Practice Address - Phone:310-402-0005
Practice Address - Fax:310-987-4655
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102607106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty