Provider Demographics
NPI:1013354422
Name:STULBERGER, MENACHEM T (MA)
Entity type:Individual
Prefix:
First Name:MENACHEM
Middle Name:T
Last Name:STULBERGER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12517 CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1925
Mailing Address - Country:US
Mailing Address - Phone:818-850-3392
Mailing Address - Fax:
Practice Address - Street 1:12517 CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1925
Practice Address - Country:US
Practice Address - Phone:818-850-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108958106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist