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General NPI Number Information
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NPI Number | 1619021607
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Entity Type | Individual
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Provider Name | JOSHUA MAFFLY M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 3700 VACA VALLEY PKWY
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City | VACAVILLE
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State | CA
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Zip | 95688-9430
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Country | US
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Telephone | 707-453-5336
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Fax |
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Provider Business Mailing Address
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Address Line | 3212 CUTTER PL
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City | DAVIS
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State | CA
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Zip | 95616-2713
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Country | US
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Telephone |
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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 | MFC33973
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License Number State | CA
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