MEDICARE: WILLOW ANXIETY AND OCD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106S00000X	Behavior Technician
2	1041C0700X	Clinical Social Worker
3	106H00000X	Marriage & Family Therapist
4	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1760174247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW ANXIETY AND OCD

Provider Business Mailing Address
First Line	:	1900 THE ALAMEDA
Second Line	:	SUITE 610/630
City	:	SAN JOSE
State	:	CA
Zip	:	95126-1404
Country	:	US
Telephone Number	:	408-475-1665
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 THE ALAMEDA
Second Line	:	SUITE 610/630
City	:	SAN JOSE
State	:	CA
Zip	:	95126-1404
Country	:	US
Telephone Number	:	408-475-1665
Fax Number	:

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	ALFREDO PEREZ
Credential	:
Telephone Number	:	408-475-1665

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	05/23/2023

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