1770028011 NPI number — MRS. GERALDINE FRANCIS FOREMAN LMFT

Table of content: MRS. GERALDINE FRANCIS FOREMAN LMFT (NPI 1770028011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770028011 NPI number — MRS. GERALDINE FRANCIS FOREMAN LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOREMAN
Provider First Name:
GERALDINE
Provider Middle Name:
FRANCIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOREMAN
Provider Other First Name:
JERI
Provider Other Middle Name:
FRANCIS
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770028011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1943 EDGEFORT CT.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-274-3391
Provider Business Mailing Address Fax Number:
408-274-3391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1885 THE ALAMEDA
Provider Second Line Business Practice Location Address:
STE 131
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
85103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-274-3391
Provider Business Practice Location Address Fax Number:
408-274-3391
Provider Enumeration Date:
12/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MFC32175 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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