Roberta Marie Faust, LMFT
Individual provider Active NPI Marriage & Family Therapist · San Jose, CA
NPI 1487956678 · NPPES record last updated Nov 22, 2010
Key facts
- NPI
- 1487956678
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 49048 (CA)
- Practice address
- 1101 S Winchester Blvd
Ste a-105
San Jose, CA 95128-3901 - Phone
- (408) 410-5029
- NPI assigned
- Nov 22, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
- Opted out of Medicare
- Yes, effective Mar 1, 2024 through Mar 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49048 | CA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 49048 | CA | Yes |
Addresses
Primary practice location
1101 S Winchester Blvd
Ste a-105
San Jose, CA 95128-3901
Mailing address
1101 S Winchester Blvd
Ste a-105
San Jose, CA 95128-3901
Phone (408) 410-5029
Other providers in San Jose, CA
- Mustafa Fattah
- Parvez Mehboob Fatteh
- Charles W. Faulk
- Jeanne Elise Faulkner
- John Richard Faull
- Josiah Faustino
- Catherine S Fausto
- Priscilla Favela
- Alfred A Fayard
- Fayaz Asghar MD Inc
All providers in San Jose, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.