Provider Demographics
NPI:1760500201
Name:ADAMS, DOROTHY (MFT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BRICKYARD WAY APT 309
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-4142
Mailing Address - Country:US
Mailing Address - Phone:650-326-6576
Mailing Address - Fax:
Practice Address - Street 1:375 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1613
Practice Address - Country:US
Practice Address - Phone:650-326-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41686101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ36408ZMedicare ID - Type Unspecified