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NPI Code Detail

MEDICARE: CHARLOTTE Y. HENDRICKS LMFT

MEDICARE: CHARLOTTE Y. HENDRICKS 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
1106H00000XMarriage & Family TherapistMFC38141CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13472OTHERCASANTA CLARA COUNTY ID

General Provider Information

NPI Number : 1619049723
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLOTTE Y. HENDRICKS LMFT
Provider Business Mailing Address
First Line : PO BOX 796
Second Line :
City : SOQUEL
State : CA
Zip : 95073-0796
Country : US
Telephone Number : 408-335-1828
Fax Number :
Provider Business Practice Location Address
First Line : 499 LOMA ALTA AVE
Second Line :
City : LOS GATOS
State : CA
Zip : 95030-6227
Country : US
Telephone Number : 408-335-1828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2006
Last Update Date : 07/08/2007

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