Provider Demographics
NPI:1043361942
Name:KOLDEWYN, SOREN (LMFT)
Entity Type:Individual
Prefix:
First Name:SOREN
Middle Name:
Last Name:KOLDEWYN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19145 EAGLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-9045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6840 VIA DEL ORO
Practice Address - Street 2:SUITE 225
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1357
Practice Address - Country:US
Practice Address - Phone:408-361-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist