Provider Demographics
NPI:1144418153
Name:WARTENBERG, MELANIE R (MFT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:R
Last Name:WARTENBERG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 SHATTUCK AVE
Mailing Address - Street 2:210
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2076
Mailing Address - Country:US
Mailing Address - Phone:510-704-7475
Mailing Address - Fax:510-704-7494
Practice Address - Street 1:2484 SHATTUCK AVE
Practice Address - Street 2:210
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2076
Practice Address - Country:US
Practice Address - Phone:510-704-7475
Practice Address - Fax:510-704-7494
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist