Provider Demographics
NPI:1649216599
Name:VANDERKAR, MARGARET ELLEN (MFT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLEN
Last Name:VANDERKAR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:PEG
Other - Middle Name:
Other - Last Name:VANDERKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:504 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9109
Mailing Address - Country:US
Mailing Address - Phone:530-295-1230
Mailing Address - Fax:530-626-8117
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9109
Practice Address - Country:US
Practice Address - Phone:530-295-1230
Practice Address - Fax:530-626-8117
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist