MEDICARE: MARIANA CHAVEZ-GEREDA 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	101Y00000X	Counselor
2	106H00000X	Marriage & Family Therapist	LMFT 90484	CA

General Provider Information

NPI Number	:	1740315613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANA CHAVEZ-GEREDA LMFT

Provider Business Mailing Address
First Line	:	3958 CASTRO VALLEY BLVD APT 23
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-6028
Country	:	US
Telephone Number	:	510-695-8769
Fax Number	:

Provider Business Practice Location Address
First Line	:	154 SANTA CLARA AVE STE 7
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-1323
Country	:	US
Telephone Number	:	106-958-7695
Fax Number	:

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	04/25/2023

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