Individual provider Active NPI

Eitan Kadosh, LMFT

  • Marriage & Family Therapist
  • Marina del Rey, CA
National Provider Identifier
1013439884
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
101254 Issued in CA
Practice address
13160 Mindanao Way Ste 213
Marina del Rey, CA 90292-6358
Phone
(925) 282-1778
NPI assigned
Jul 12, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 101254 CA Primary

Addresses

Primary practice location

13160 Mindanao Way Ste 213
Marina del Rey, CA 90292-6358

Mailing address

13160 Mindanao Way Ste 213
Marina del Rey, CA 90292-6358

Other practice location 1

1450 10th St Ste 404
Santa Monica, CA 90401-2831
Phone (925) 282-1778

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240912001351 CA Practitioner - Marriage and Family Therapist 8426598830 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians

Practice addresses (Care Compare)

13160 Mindanao Way
Suite 213
Marina del Rey, CA 90292-6358
Phone (925) 282-1778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
101254CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Coast Psychiatric Associates Inc CurrentSince Jul 30, 2024 Accepting new patients

Locations

6200 Wilshire Blvd
Ste 1410
Los Angeles, CA 90048
Phone (323) 403-0474

13160 Mindanao Way
Ste 213
Marina del Rey, CA 90292

490 Post St
Ste 1043
San Francisco, CA 94102
Phone (415) 409-0944

1450 10th St
Ste 404
Santa Monica, CA 90401
Phone (310) 451-8144

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.eitankadosh@148377.advancedmd-direct.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1013439884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13160 MINDANAO WAY STE 213",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13160 MINDANAO WAY STE 213",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926358",
            "telephone_number": "925-282-1778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1450 10th St Ste 404",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904012831",
            "country_code": "US",
            "telephone_number": "925-282-1778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KADOSH",
        "first_name": "EITAN",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-12",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "101254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marina del Rey, CA

Sources for this page

Verify at the official NPI Registry.