Provider Demographics
NPI:1861630618
Name:MENDELSOHN, ROBERT L (MFT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:MENDELSOHN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 S BARRINGTON PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3305
Mailing Address - Country:US
Mailing Address - Phone:310-923-6233
Mailing Address - Fax:323-937-3487
Practice Address - Street 1:179 S BARRINGTON PL
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3305
Practice Address - Country:US
Practice Address - Phone:310-923-6233
Practice Address - Fax:323-937-3487
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39142106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist