Provider Demographics
NPI:1447732292
Name:DIPANNI, ADAM DANIEL (MFT)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:DANIEL
Last Name:DIPANNI
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 1:16530 VENTURA BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4504
Mailing Address - Country:US
Mailing Address - Phone:818-501-4240
Mailing Address - Fax:818-501-0470
Practice Address - Street 1:16530 VENTURA BLVD STE 510
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4504
Practice Address - Country:US
Practice Address - Phone:818-501-4240
Practice Address - Fax:818-501-0470
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT108507106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist