MEDICARE: LAURA ARDZROONI DREYER

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	38486	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38486	OTHER	CA	LISENCE

General Provider Information

NPI Number	:	1942765342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ARDZROONI DREYER

Provider Business Mailing Address
First Line	:	3093 SACRAMENTO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3093 SACRAMENTO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2016
Country	:	US
Telephone Number	:	415-596-3364
Fax Number	:

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

Provider Enumeration Date	:	02/10/2019
Last Update Date	:	02/10/2019

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