Provider Demographics
NPI:1497346134
Name:ELIZABETH DANDENELL MARRIAGE AND FAMILY THERAPIST INC
Entity Type:Organization
Organization Name:ELIZABETH DANDENELL MARRIAGE AND FAMILY THERAPIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DANDENELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-310-6684
Mailing Address - Street 1:425 CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6136
Mailing Address - Country:US
Mailing Address - Phone:510-508-8228
Mailing Address - Fax:
Practice Address - Street 1:2223 SANTA CLARA AVE STE B5
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4469
Practice Address - Country:US
Practice Address - Phone:510-748-0637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty