=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770681892
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH S. ADLER MFC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 03/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 MORRIS ST SUITE 203
-----------------------------------------------------
City | SEBASTOPOL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-992-0262
-----------------------------------------------------
Fax | 707-795-6745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 W SCHOOL ST
-----------------------------------------------------
City | COTATI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-992-0262
-----------------------------------------------------
Fax | 707-795-6745
-----------------------------------------------------
=====================================================
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 | MFC34916
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------