Provider Demographics
NPI:1760002398
Name:FROEBERG, MACKENZIE LAUREN (MA)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LAUREN
Last Name:FROEBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 ALPINE RD STE 180
Mailing Address - Street 2:
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-7521
Mailing Address - Country:US
Mailing Address - Phone:650-827-5600
Mailing Address - Fax:
Practice Address - Street 1:3130 ALPINE RD STE 180
Practice Address - Street 2:
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-7521
Practice Address - Country:US
Practice Address - Phone:650-827-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist