Provider Demographics
NPI:1952788192
Name:HURWITZ-PROVDA, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:HURWITZ-PROVDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22836 MARGARITA DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-3843
Mailing Address - Country:US
Mailing Address - Phone:310-592-8576
Mailing Address - Fax:
Practice Address - Street 1:23632 CALABASAS RD
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1553
Practice Address - Country:US
Practice Address - Phone:310-592-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health