Provider Demographics
NPI:1225514292
Name:MENZIE, EMMA JACQUELINE (LMFT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:JACQUELINE
Last Name:MENZIE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:BRODGINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3800 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6010 W BROAD ST STE 103
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2215
Practice Address - Country:US
Practice Address - Phone:804-282-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAAMFT184133106H00000X
VA0717001831106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health