Provider Demographics
NPI:1699908665
Name:BROSH, DIANE HOLZMAN (MFT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:HOLZMAN
Last Name:BROSH
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 1:28310 ROADSIDE DR
Mailing Address - Street 2:SUITE #140
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4923
Mailing Address - Country:US
Mailing Address - Phone:818-889-5423
Mailing Address - Fax:818-597-0235
Practice Address - Street 1:28310 ROADSIDE DR
Practice Address - Street 2:SUITE #140
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4923
Practice Address - Country:US
Practice Address - Phone:818-889-5423
Practice Address - Fax:818-597-0235
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31438106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist