Healthcare Provider Details

I. General information

NPI: 1689997637
Provider Name (Legal Business Name): PAUL E. MARGOLIS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 GOSSAGE WAY
PETALUMA CA
94952-6342
US

IV. Provider business mailing address

194 GOSSAGE WAY
PETALUMA CA
94952-6342
US

V. Phone/Fax

Practice location:
  • Phone: 707-322-1929
  • Fax:
Mailing address:
  • Phone: 707-322-1929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC34259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: