MEDICARE: MARTHA CLARK SCALA MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC30222	CA

General Provider Information

NPI Number	:	1053576439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA CLARK SCALA MFT

Provider Business Mailing Address
First Line	:	721 COLORADO AVE
Second Line	:	SUITE 201
City	:	PALO ALTO
State	:	CA
Zip	:	94303-3972
Country	:	US
Telephone Number	:	650-322-6430
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 COLORADO AVE
Second Line	:	SUITE 201
City	:	PALO ALTO
State	:	CA
Zip	:	94303-3972
Country	:	US
Telephone Number	:	650-322-6430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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