MEDICARE: SUZANNE PREGERSON 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	101YM0800X	Mental Health Counselor	MFT 8734	CA

General Provider Information

NPI Number	:	1396778106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE PREGERSON MFT

Provider Business Mailing Address
First Line	:	2111 VINE ST
Second Line	:	SUITE A
City	:	BERKELEY
State	:	CA
Zip	:	94709-1576
Country	:	US
Telephone Number	:	510-548-1237
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 VINE ST
Second Line	:	SUITE A
City	:	BERKELEY
State	:	CA
Zip	:	94709-1576
Country	:	US
Telephone Number	:	510-548-1237
Fax Number	:

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/08/2007

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