=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144489220
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAOMI BICK RICHMAN MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2008
-----------------------------------------------------
Last Update Date | 12/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 WELLER ST STE. 201
-----------------------------------------------------
City | PETALUMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94952-3136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-762-5086
-----------------------------------------------------
Fax | 707-765-9210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 KEOKUK ST
-----------------------------------------------------
City | PETALUMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94952-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-762-5086
-----------------------------------------------------
Fax | 707-765-9210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFT 8763
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------