Provider Demographics
NPI:1952595829
Name:MANN, ROBERT ISRAEL (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ISRAEL
Last Name:MANN
Suffix:
Gender:M
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 1:4444 RIVERSIDE DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4048
Mailing Address - Country:US
Mailing Address - Phone:818-445-9965
Mailing Address - Fax:818-845-4341
Practice Address - Street 1:4444 RIVERSIDE DR
Practice Address - Street 2:SUITE 208
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4048
Practice Address - Country:US
Practice Address - Phone:818-445-9965
Practice Address - Fax:818-845-4341
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 21638106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist