Provider Demographics
NPI:1033328935
Name:BALDIOLI, VIRGINIA B (LMFT MARRIAGE & FAMI)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:B
Last Name:BALDIOLI
Suffix:
Gender:F
Credentials:LMFT MARRIAGE & FAMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 VAN NUYS BLVD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405
Mailing Address - Country:US
Mailing Address - Phone:818-786-2079
Mailing Address - Fax:818-304-0714
Practice Address - Street 1:6850 VAN NUYS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4629
Practice Address - Country:US
Practice Address - Phone:818-786-2079
Practice Address - Fax:818-304-0714
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23829 MFT103TP2701X
CA23829106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy