Provider Demographics
NPI:1154902708
Name:FERRARA, AMANDA (LMFT#125876)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FERRARA
Suffix:
Gender:F
Credentials:LMFT#125876
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 MANHATTAN BEACH BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4982
Mailing Address - Country:US
Mailing Address - Phone:310-994-6153
Mailing Address - Fax:
Practice Address - Street 1:700 N PACIFIC COAST HWY STE 301
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2147
Practice Address - Country:US
Practice Address - Phone:310-994-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT113155106H00000X
CA125876106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist