MEDICARE: MS. LAURA E TANNENWALD MFT

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	MFC33555	CA

General Provider Information

NPI Number	:	1417095548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA E TANNENWALD MFT

Provider Business Mailing Address
First Line	:	PO BOX 51904
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94303-0739
Country	:	US
Telephone Number	:	619-857-6332
Fax Number	:

Provider Business Practice Location Address
First Line	:	4546 EL CAMINO REAL STE 235
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1041
Country	:	US
Telephone Number	:	619-857-6332
Fax Number	:

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	11/06/2022

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