MEDICARE: SUSAN WILLIAMS BARLETTANI

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	MC34354	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MC34354	OTHER	CA	LICIENCE NUMBER

General Provider Information

NPI Number	:	1750787016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN WILLIAMS BARLETTANI

Provider Business Mailing Address
First Line	:	1003 RIDGEVIEW PL
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-1159
Country	:	US
Telephone Number	:	925-906-5345
Fax Number	:

Provider Business Practice Location Address
First Line	:	1866 CLAYTON RD
Second Line	:	SUITE 103
City	:	CONCORD
State	:	CA
Zip	:	94520-2555
Country	:	US
Telephone Number	:	925-906-5345
Fax Number	:

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

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	11/14/2014

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