MEDICARE: MR. PAUL E. MARGOLIS 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	MFC34259	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
2	MFC34259	OTHER	CA	BOARD OF BEHAVIORAL SCIENCES

General Provider Information

NPI Number	:	1689997637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL E. MARGOLIS LMFT

Provider Business Mailing Address
First Line	:	PO BOX 9591
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-1591
Country	:	US
Telephone Number	:	707-284-1978
Fax Number	:	707-708-2188

Provider Business Practice Location Address
First Line	:	3434 MENDOCINO AVE
Second Line	:	SUITE A
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2274
Country	:	US
Telephone Number	:	707-284-1978
Fax Number	:	707-708-2188

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

Provider Enumeration Date	:	03/04/2010
Last Update Date	:	02/09/2017

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