Provider Information for 1033239918
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Ms. MARA STEPHANIE BRUCKNER M.A., M.F.T.
Sex: Female
NPI: 1033239918
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1033239918 | ||||||||
| Enumeration Date | 2007-04-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 22040 VISCANIO RD WOODLAND HILLS, CA 91364-4110 United States Phone: 818-725-7924 | Fax:818-713-0923 | ||||||||
| Primary Practice Address | 6340 VARIEL AVE SUITE A WOODLAND HILLS, CA 91367-2514 United States Phone: 818-725-7924 | Fax:818-888-4005 | ||||||||
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