Provider Demographics
NPI:1639517345
Name:WEGLARZ, PHILLIP M (MFT, REAT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:M
Last Name:WEGLARZ
Suffix:
Gender:M
Credentials:MFT, REAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 FLORIO ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1352
Mailing Address - Country:US
Mailing Address - Phone:415-939-4743
Mailing Address - Fax:
Practice Address - Street 1:6214 FLORIO ST UNIT 3
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1352
Practice Address - Country:US
Practice Address - Phone:415-939-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48479106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist