Provider Demographics
NPI:1285803676
Name:ZAGELBAUM, VALORIE (MFT)
Entity type:Individual
Prefix:
First Name:VALORIE
Middle Name:
Last Name:ZAGELBAUM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15336 DEVONSHIRE ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2755
Mailing Address - Country:US
Mailing Address - Phone:323-538-0975
Mailing Address - Fax:818-484-4084
Practice Address - Street 1:501 S FAIRFAX AVE STE 214
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3198
Practice Address - Country:US
Practice Address - Phone:323-538-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27615103TF0000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063881894Medicaid