MEDICARE: SONOMA COUNTY CHILD & FAMILY COUNSELING, INC.

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	LMFT34259	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639617699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONOMA COUNTY CHILD & FAMILY COUNSELING, INC.

Provider Business Mailing Address
First Line	:	3434 MENDOCINO AVE # A
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2274
Country	:	US
Telephone Number	:	707-322-1929
Fax Number	:	707-708-2188

Provider Business Practice Location Address
First Line	:	3434 MENDOCINO AVE # A
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2274
Country	:	US
Telephone Number	:	707-322-1929
Fax Number	:	707-708-2188

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL ELIOT MARGOLIS
Credential	:	LMFT
Telephone Number	:	707-322-1929

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	06/12/2017

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