MEDICARE: MS. JONI EDELMAN 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	MFC33515	CA

General Provider Information

NPI Number	:	1477683209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JONI EDELMAN LMFT

Provider Business Mailing Address
First Line	:	13223 BLACK MOUNTAIN RD # 242
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2698
Country	:	US
Telephone Number	:	805-501-5838
Fax Number	:

Provider Business Practice Location Address
First Line	:	13223 BLACK MOUNTAIN RD # 242
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2698
Country	:	US
Telephone Number	:	805-501-5838
Fax Number	:

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	05/21/2012

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