MEDICARE: VALERIE WAAGEN 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	MFC44347	CA

General Provider Information

NPI Number	:	1396023354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE WAAGEN MFT

Provider Business Mailing Address
First Line	:	6531 CROWN BLVD STE 3B
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2906
Country	:	US
Telephone Number	:	408-380-3033
Fax Number	:

Provider Business Practice Location Address
First Line	:	6531 CROWN BLVD STE 3B
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2906
Country	:	US
Telephone Number	:	408-380-3033
Fax Number	:

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

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	07/25/2011

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Directions to “ VALERIE WAAGEN MFT” Practice Location

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