MEDICARE: JULIE BEDELL MANENTE MA, LMFT

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	LMFT42325	CA
2	106H00000X	Marriage & Family Therapist	42325	CA

General Provider Information

NPI Number	:	1265823371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE BEDELL MANENTE MA, LMFT

Provider Business Mailing Address
First Line	:	2386 FARADAY AVE STE 140
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-7222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2386 FARADAY AVE STE 140
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-7222
Country	:	US
Telephone Number	:	760-496-9394
Fax Number	:

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

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	12/10/2020

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