Provider Demographics
NPI:1710908579
Name:FETZ, DANA ROBERT (MA)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:ROBERT
Last Name:FETZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 HILLTOP MALL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1921
Mailing Address - Country:US
Mailing Address - Phone:510-741-0721
Mailing Address - Fax:510-758-1928
Practice Address - Street 1:3150 HILLTOP MALL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1921
Practice Address - Country:US
Practice Address - Phone:510-741-0721
Practice Address - Fax:510-758-1928
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29024106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist