MEDICARE: MERRILEE ANNE VUSCOVICH MFTI

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	IMF52708	CA

General Provider Information

NPI Number	:	1700062429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERRILEE ANNE VUSCOVICH MFTI

Provider Business Mailing Address
First Line	:	2251 FAIR OAKS BLVD STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-5530
Country	:	US
Telephone Number	:	916-933-9467
Fax Number	:

Provider Business Practice Location Address
First Line	:	2251 FAIR OAKS BLVD STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-5530
Country	:	US
Telephone Number	:	916-933-9467
Fax Number	:

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

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/25/2008

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