Provider Demographics
NPI:1588870414
Name:SCHWARZ, ROGER (MFT)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:SCHWARZ
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 MANNIX DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-1938
Mailing Address - Country:US
Mailing Address - Phone:310-614-0604
Mailing Address - Fax:323-848-9983
Practice Address - Street 1:15720 VENTURA BLVD
Practice Address - Street 2:#232
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2914
Practice Address - Country:US
Practice Address - Phone:310-614-0604
Practice Address - Fax:323-848-9983
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist