Provider Demographics
NPI:1700101276
Name:ESPINOZA, MARY (MFT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29755 CASTLEBURY PL
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3823
Mailing Address - Country:US
Mailing Address - Phone:818-370-3108
Mailing Address - Fax:661-295-8752
Practice Address - Street 1:14724 VENTURA BLVD
Practice Address - Street 2:STE 1100
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3501
Practice Address - Country:US
Practice Address - Phone:310-551-7705
Practice Address - Fax:661-295-8752
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25459106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist