MEDICARE: DENNIS JOSEPH WASCO MA, 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	MFC 50434	CA

General Provider Information

NPI Number	:	1427196344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS JOSEPH WASCO MA, MFT

Provider Business Mailing Address
First Line	:	509 W 10TH ST
Second Line	:
City	:	ANTIOCH
State	:	CA
Zip	:	94509-1653
Country	:	US
Telephone Number	:	925-852-5280
Fax Number	:	925-757-9024

Provider Business Practice Location Address
First Line	:	579 MT OLIVET PL
Second Line	:
City	:	CLAYTON
State	:	CA
Zip	:	94517-1609
Country	:	US
Telephone Number	:	925-852-5280
Fax Number	:	925-757-9024

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	09/25/2013

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