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General NPI Number Information
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NPI Number | 1083825673
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Entity Type | Individual
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Provider Name | RENE F DVALERY LMFT
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 1275 4TH ST # 5055
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City | SANTA ROSA
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State | CA
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Zip | 95404-4057
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Country | US
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Telephone | 510-451-3000
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Fax | 510-298-5696
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Provider Business Mailing Address
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Address Line | 1596 WRIGHT ST
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City | SANTA ROSA
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State | CA
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Zip | 95404-2928
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Country | US
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Telephone | 415-420-5572
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Fax | 510-298-5696
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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 | MFC46693
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License Number State | CA
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