1497134712 NPI number — SALLIE DANENBERG, LMFT

Table of content: (NPI 1497134712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497134712 NPI number — SALLIE DANENBERG, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALLIE DANENBERG, LMFT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497134712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1777 HAMILTON AVE
Provider Second Line Business Mailing Address:
SUITE 2380
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95125-5430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-600-9722
Provider Business Mailing Address Fax Number:
408-266-8545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1777 HAMILTON AVE
Provider Second Line Business Practice Location Address:
SUITE 2380
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95125-5430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-600-9722
Provider Business Practice Location Address Fax Number:
408-266-8545
Provider Enumeration Date:
05/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DANENBERG
Authorized Official First Name:
SALLIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
408-266-8544

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MFC25414 , 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)

  • Identifier: MFC25414 . This is a "STATE LICENSE NUMBER ASSIGNED BY CA. BBSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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