Healthcare Provider Details

I. General information

NPI: 1730219189
Provider Name (Legal Business Name): SOPHIE DUFAULT M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 ARCH ST
REDWOOD CITY CA
94062-1303
US

IV. Provider business mailing address

3607 HILLCREST DR.
BELMONT CA
94002-1305
US

V. Phone/Fax

Practice location:
  • Phone: 650-363-0383
  • Fax: 650-363-0436
Mailing address:
  • Phone: 650-594-1667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC36703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: