Healthcare Provider Details

I. General information

NPI: 1700443942
Provider Name (Legal Business Name): HEATHER MARIE SCHRAG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER MARIE JONES

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 TELEGRAPH AVE # 94705
BERKELEY CA
94705-1117
US

IV. Provider business mailing address

10 HILLCREST RD
BERKELEY CA
94705-2807
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-8283
  • Fax:
Mailing address:
  • Phone: 510-277-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: