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General NPI Number Information
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NPI Number | 1891071676
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Entity Type | Individual
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Provider Name | MARTHA IRENE DAGGETT DSW, MS, LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 1251 CLAY ST
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City | REDLANDS
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State | CA
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Zip | 92374-3257
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Country | US
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Telephone | 909-798-4599
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1173
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City | REDLANDS
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State | CA
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Zip | 92373-0381
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Country | US
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Telephone | 909-229-6405
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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 | 71634
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License Number State | CA
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