MEDICARE: MRS. JOLENE MARIE TRAUD 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	90719	CA

General Provider Information

NPI Number	:	1548429335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOLENE MARIE TRAUD LMFT

Provider Business Mailing Address
First Line	:	1530 MERIDIAN AVE STE 200
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5318
Country	:	US
Telephone Number	:	510-922-9757
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 BAY STATE CT
Second Line	:
City	:	GOLD RIVER
State	:	CA
Zip	:	95670-8135
Country	:	US
Telephone Number	:	925-487-7827
Fax Number	:

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

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	08/30/2023

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