Provider Demographics
NPI:1093273666
Name:REIFMAN, CARLY (LMFT, ATR)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:REIFMAN
Suffix:
Gender:F
Credentials:LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E OLIVE AVE # 223
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1820
Mailing Address - Country:US
Mailing Address - Phone:818-533-1619
Mailing Address - Fax:
Practice Address - Street 1:1028 CRAGMONT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94708-1412
Practice Address - Country:US
Practice Address - Phone:818-533-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist