1073654372 NPI number — EMILY JOANNE DAMIELLS MFT

Table of content: EMILY JOANNE DAMIELLS MFT (NPI 1073654372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073654372 NPI number — EMILY JOANNE DAMIELLS MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAMIELLS
Provider First Name:
EMILY
Provider Middle Name:
JOANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073654372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5675 TELEGRAPH RD
Provider Second Line Business Mailing Address:
STE. 200
Provider Business Mailing Address City Name:
COMMERCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90040-1570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-838-9566
Provider Business Mailing Address Fax Number:
323-838-9572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5675 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
COMMERCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90040-1570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-838-9566
Provider Business Practice Location Address Fax Number:
323-838-9572
Provider Enumeration Date:
02/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  52791 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)