Provider Demographics
NPI:1659789345
Name:SCHWEBEL, MARTIN LEE
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:LEE
Last Name:SCHWEBEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WESTERN AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2979
Mailing Address - Country:US
Mailing Address - Phone:707-658-1465
Mailing Address - Fax:
Practice Address - Street 1:24 WESTERN AVE STE 308
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2979
Practice Address - Country:US
Practice Address - Phone:707-347-9568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-26
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist