MEDICARE: DEBORAH BOATWRIGHT EDGAR MFT

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	44379	CA

General Provider Information

NPI Number	:	1649390873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH BOATWRIGHT EDGAR MFT

Provider Business Mailing Address
First Line	:	225 S LAKE AVE
Second Line	:	SUITE 300
City	:	PASADENA
State	:	CA
Zip	:	91101-3005
Country	:	US
Telephone Number	:	626-432-7212
Fax Number	:	626-432-7213

Provider Business Practice Location Address
First Line	:	225 S LAKE AVE
Second Line	:	SUITE 300
City	:	PASADENA
State	:	CA
Zip	:	91101-3005
Country	:	US
Telephone Number	:	626-432-7212
Fax Number	:	626-432-7213

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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