Active NPI
Amanda Nabil Eldabh, LCSW
- Mental Health Counselor
- Burbank, CA
National Provider Identifier
1679092944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 101210
- Practice address
- 191 S Buena Vista St
Burbank, CA 91505-4554 - Phone
- (424) 284-2440
- Fax
- (415) 296-5299
- NPI assigned
- Sep 18, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CA | ||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Mental Health Counselor | 101YM0800X | 101210 | CA | Primary |
Addresses
Primary practice location
191 S Buena Vista St
Burbank, CA 91505-4554
Mailing address
191 S Buena Vista St Ste 300
Burbank, CA 91505-4556
Phone (424) 284-2440
Other practice location 1
16350 Filbert St
Sylmar, CA 91342-1002
Phone (818) 364-2152
Other practice location 2
43520 Division St
Lancaster, CA 93535
Phone (661) 266-4783
Other practice location 3
43520 Division St
Lancaster, CA 93535
Phone (661) 266-4783
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 95-2633765 | Other | CA | MEDI-CAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101210 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641168000000",
"number": "1679092944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "191 S BUENA VISTA ST STE 300",
"city": "BURBANK",
"state": "CA",
"postal_code": "915054556",
"telephone_number": "424-284-2440",
"fax_number": "415-296-5299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "191 S BUENA VISTA ST",
"city": "BURBANK",
"state": "CA",
"postal_code": "915054554",
"telephone_number": "424-284-2440",
"fax_number": "415-296-5299"
}
],
"practiceLocations": [
{
"address_1": "16350 Filbert St",
"address_purpose": "LOCATION",
"city": "Sylmar",
"state": "CA",
"postal_code": "913421002",
"country_code": "US",
"telephone_number": "818-364-2152",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "43520 Division St",
"address_purpose": "LOCATION",
"city": "Lancaster",
"state": "CA",
"postal_code": "93535",
"country_code": "US",
"telephone_number": "661-266-4783",
"fax_number": "661-266-1210",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "43520 Division St",
"address_purpose": "LOCATION",
"city": "Lancaster",
"state": "CA",
"postal_code": "93535",
"country_code": "US",
"telephone_number": "661-266-4783",
"fax_number": "661-266-1210",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ELDABH",
"first_name": "AMANDA",
"middle_name": "NABIL",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-18",
"last_updated": "2022-01-03",
"certification_date": "2021-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "101210",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL",
"identifier": "95-2633765",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burbank, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.