Provider Demographics
NPI:1548916828
Name:SANTANA, REBECCA MARIE (MA, LMFT, ATR)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:SANTANA
Suffix:
Gender:F
Credentials:MA, LMFT, ATR
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:YERETZIAN-SANTANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT, ATR
Mailing Address - Street 1:505 N AVON ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3535
Mailing Address - Country:US
Mailing Address - Phone:818-932-4862
Mailing Address - Fax:
Practice Address - Street 1:505 N AVON ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3535
Practice Address - Country:US
Practice Address - Phone:818-932-4862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18-484221700000X
CA124237106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist