MEDICARE: MRS. MASAKO GUTHRIE 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	43333	CA

General Provider Information

NPI Number	:	1417229717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MASAKO GUTHRIE LMFT

Provider Business Mailing Address
First Line	:	3041 TREMONT ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-2549
Country	:	US
Telephone Number	:	510-665-4118
Fax Number	:	510-548-4119

Provider Business Practice Location Address
First Line	:	3041 TREMONT ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-2549
Country	:	US
Telephone Number	:	510-665-4118
Fax Number	:	510-548-4119

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

Provider Enumeration Date	:	02/01/2012
Last Update Date	:	02/01/2012

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