Provider Demographics
NPI:1730157132
Name:PADVEEN, MARIE JANET (MFC)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:JANET
Last Name:PADVEEN
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:JANET
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2566 OVERLAND AVE
Mailing Address - Street 2:500A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064
Mailing Address - Country:US
Mailing Address - Phone:310-588-0090
Mailing Address - Fax:310-836-2312
Practice Address - Street 1:2566 OVERLAND AVE
Practice Address - Street 2:500A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064
Practice Address - Country:US
Practice Address - Phone:310-588-0090
Practice Address - Fax:310-836-2312
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33209106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMF2009730Medicaid