Provider Demographics
NPI:1952675712
Name:HEDWALL, VAN NEWMAN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:VAN
Middle Name:NEWMAN
Last Name:HEDWALL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HAIGHT ST APT 607
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5745
Mailing Address - Country:US
Mailing Address - Phone:415-863-3122
Mailing Address - Fax:
Practice Address - Street 1:1480 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2050
Practice Address - Country:US
Practice Address - Phone:415-863-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49868106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist