Provider Demographics
NPI:1811024714
Name:DAGENHART, NANCY (MFT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DAGENHART
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:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94977-0573
Mailing Address - Country:US
Mailing Address - Phone:415-924-4539
Mailing Address - Fax:415-891-8087
Practice Address - Street 1:100 TAMAL PLZ STE 100
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1161
Practice Address - Country:US
Practice Address - Phone:415-924-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33222106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist