MEDICARE: CARRIE F. ANDERSON M.S.

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 50219	CA

General Provider Information

NPI Number	:	1720265671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE F. ANDERSON M.S.

Provider Business Mailing Address
First Line	:	PO BOX 1573
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-0172
Country	:	US
Telephone Number	:	510-395-5218
Fax Number	:

Provider Business Practice Location Address
First Line	:	3798 GRAND AVE STE 2
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-1527
Country	:	US
Telephone Number	:	510-395-5218
Fax Number	:

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

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/15/2020

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