MEDICARE: MRS. AMBER DAWN HAWLEY LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	49614	CA

General Provider Information

NPI Number	:	1174819346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMBER DAWN HAWLEY LMFT

Provider Business Mailing Address
First Line	:	PO BOX 1084
Second Line	:
City	:	NEWARK
State	:	CA
Zip	:	94560-6084
Country	:	US
Telephone Number	:	510-342-3263
Fax Number	:	510-342-3263

Provider Business Practice Location Address
First Line	:	38970 BLACOW RD STE C
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94536-7380
Country	:	US
Telephone Number	:	510-342-3263
Fax Number	:	510-342-3263

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2011
Last Update Date	:	06/25/2011

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