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NPI Code Detail

MEDICARE: MR. PETER BRIAN FOGEL LMFT

MEDICARE: MR. PETER BRIAN FOGEL 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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1417007865
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PETER BRIAN FOGEL LMFT
Provider Business Mailing Address
First Line : 689 44TH AVE
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94121-2506
Country : US
Telephone Number : 415-260-2133
Fax Number :
Provider Business Practice Location Address
First Line : 890 HAYES ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94117-2615
Country : US
Telephone Number : 415-701-5114
Fax Number : 415-252-9488
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 07/08/2007

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Directions to “ MR. PETER BRIAN FOGEL LMFT” Practice Location

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