Provider Demographics
NPI:1962419564
Name:BLUMENKRANTZ, BONNIE MAE (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:MAE
Last Name:BLUMENKRANTZ
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8929 S SEPULVEDA BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3616
Mailing Address - Country:US
Mailing Address - Phone:310-822-5688
Mailing Address - Fax:310-899-5604
Practice Address - Street 1:8929 S SEPULVEDA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3616
Practice Address - Country:US
Practice Address - Phone:310-822-5688
Practice Address - Fax:310-899-5604
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist