Provider Demographics
NPI:1104336197
Name:REITMAN, ANDREA BETH (AMFT/APCC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:BETH
Last Name:REITMAN
Suffix:
Gender:F
Credentials:AMFT/APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1656
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1656
Mailing Address - Country:US
Mailing Address - Phone:310-882-8453
Mailing Address - Fax:
Practice Address - Street 1:1840 FAIRBURN AVE APT 308
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4923
Practice Address - Country:US
Practice Address - Phone:310-882-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145812106H00000X
CAAPCC4903101YP2500X
CAAMFT105274101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAMFT105274OtherBBS