Healthcare Provider Details

I. General information

NPI: 1497940324
Provider Name (Legal Business Name): JANEECE M DAGEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MASONIC
SAN FRANCISCO CA
94118
US

IV. Provider business mailing address

PO BOX 3618
WALNUT CREEK CA
94598
US

V. Phone/Fax

Practice location:
  • Phone: 415-776-2717
  • Fax: 925-280-1264
Mailing address:
  • Phone: 925-930-6135
  • Fax: 925-280-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFTMFC17763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: