MEDICARE: FAMILY SYSTEMS AND CHILD THERAPY, INC.

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

General Provider Information

NPI Number	:	1679031736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY SYSTEMS AND CHILD THERAPY, INC.

Provider Business Mailing Address
First Line	:	2878 CAMINO DEL RIO S STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3845
Country	:	US
Telephone Number	:	619-784-6793
Fax Number	:

Provider Business Practice Location Address
First Line	:	2878 CAMINO DEL RIO S STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3845
Country	:	US
Telephone Number	:	619-784-6793
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	THI WLODARSKI
Credential	:	LMFT
Telephone Number	:	619-784-6703

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	03/07/2019

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