MEDICARE: MS. SHEILA HOGAN LONGERBEAM M.F.T.

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	27856	CA

General Provider Information

NPI Number	:	1619099983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHEILA HOGAN LONGERBEAM M.F.T.

Provider Business Mailing Address
First Line	:	4230 DETROIT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94619-1602
Country	:	US
Telephone Number	:	510-530-6203
Fax Number	:

Provider Business Practice Location Address
First Line	:	3852 PIEDMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-5353
Country	:	US
Telephone Number	:	510-595-4664
Fax Number	:

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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