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General NPI Number Information
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NPI Number | 1063881886
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Entity Type | Individual
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Provider Name | RONALD NIEWALD MA, LMFT
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Gender | Male
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 1811 SANTA RITA RD SUITE 207
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City | PLEASANTON
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State | CA
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Zip | 94566-4746
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Country | US
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Telephone | 650-799-6485
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 GIANNA LN
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City | MANTECA
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State | CA
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Zip | 95336-6454
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Country | US
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Telephone | 650-799-6485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 87246
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License Number State | CA
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