MEDICARE: JOYCE WATERMAN 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	MFC29861	CA

General Provider Information

NPI Number	:	1710146717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE WATERMAN LMFT

Provider Business Mailing Address
First Line	:	11600 WASHINGTON PL
Second Line	:	202D
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5033
Country	:	US
Telephone Number	:	310-397-5767
Fax Number	:

Provider Business Practice Location Address
First Line	:	11600 WASHINGTON PL
Second Line	:	202D
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5033
Country	:	US
Telephone Number	:	310-397-5767
Fax Number	:

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

Provider Enumeration Date	:	06/04/2008
Last Update Date	:	06/04/2008

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