Provider Demographics
NPI:1457439671
Name:RADESKI, MEGAN M (MA MFT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:RADESKI
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MCDOUGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:640 61ST ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1206
Mailing Address - Country:US
Mailing Address - Phone:510-914-3221
Mailing Address - Fax:
Practice Address - Street 1:640 61ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1206
Practice Address - Country:US
Practice Address - Phone:510-914-3221
Practice Address - Fax:510-663-9059
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 25784106H00000X
CA25784106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist