Individual provider Active NPI

Robert J Dalzell, MFT

  • Marriage & Family Therapist
  • Petaluma, CA
National Provider Identifier
1649342700
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFC29489 Issued in CA
Practice address
7 4TH St
Suite 10
Petaluma, CA 94952-3043
Phone
(707) 765-1009
Fax
(707) 765-1009
NPI assigned
Nov 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFC29489 CA Primary

Addresses

Primary practice location

7 4TH St
Suite 10
Petaluma, CA 94952-3043

Mailing address

7 4TH St
Suite 10
Petaluma, CA 94952-3043
Phone (707) 765-1009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MFC29489CAMDMarriage & Family Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649342700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 4TH ST",
            "address_2": "SUITE 10",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949523043",
            "telephone_number": "707-765-1009",
            "fax_number": "707-765-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 4TH ST",
            "address_2": "SUITE 10",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949523043",
            "telephone_number": "707-765-1009",
            "fax_number": "707-765-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALZELL",
        "first_name": "ROBERT",
        "middle_name": "J",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC29489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petaluma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.