MEDICARE: SONOMA THERAPY NETWORK

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1356854673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONOMA THERAPY NETWORK

Provider Business Mailing Address
First Line	:	3438 MENDOCINO AVE STE B
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2275
Country	:	US
Telephone Number	:	707-387-4525
Fax Number	:	707-861-9292

Provider Business Practice Location Address
First Line	:	3438 MENDOCINO AVE STE B
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2275
Country	:	US
Telephone Number	:	707-387-4525
Fax Number	:	707-843-5574

Authorized Official
Title or Position	:	OWNER
Name	:	GARET DAVID WATERHOUSE
Credential	:	LCSW
Telephone Number	:	707-387-4525

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	05/19/2022

Similar Medicare Providers

1194888941 — MRS. PATRICIA LEE MILLS LMFT
Practice Location Address:

3438 MENDOCINO AVE # B
SANTA ROSA, CA
95403-2275

Practice Phone: 707-529-3721
Practice Fax: 707-900-8192

1629196977 — DEBORAH L LEV-ER MSW LCSW
Practice Location Address:

3438 MENDOCINO AVE # B
SANTA ROSA, CA
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Practice Fax:

1447425913 — GARET DAVID WATERHOUSE LCSW
Practice Location Address:

3438 MENDOCINO AVE # B
SANTA ROSA, CA
95403-2275

Practice Phone: 707-387-4525
Practice Fax: 707-861-9292

1013497544 — ASHLEY MIA MORGAN LCSW
Practice Location Address:

3438 MENDOCINO AVE STE B
SANTA ROSA, CA
95403-2275

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1437156684 — MARY E HARTMAN M.D.
Practice Location Address:

601 E ARRELLAGA ST STE 101
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1437355260 — RIKK LYNN M.D.
Practice Location Address:

601 E ARRELLAGA ST , STE 101
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Directions to “SONOMA THERAPY NETWORK ” Practice Location

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