Melissa Lee Van Wagenen, LMFTI

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

IMF96544 Issued in CA

Practice address

643 Bair Island Rd # 301
Redwood City, CA 94063-2754

Phone

(650) 424-0852

NPI assigned

Jun 23, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Adolescent Counseling Services

  • Community/Behavioral Health Agency
  • Redwood City, CA
  • NPI 1457807810
  NPD (past)

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

{
    "created_epoch": "1498176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498176000000",
    "number": "1902326507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92152",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911092152",
            "telephone_number": "818-720-9152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "643 BAIR ISLAND RD # 301",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940632754",
            "telephone_number": "650-424-0852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN WAGENEN",
        "first_name": "MELISSA",
        "middle_name": "LEE",
        "credential": "LMFTI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-23",
        "last_updated": "2017-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF96544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roland J. Vallecillo, MD
• Janelle Van Der Linde
• Julia Tsai Van Helmond
• Jenee Van Hofwegen
• Lydia Van Vleet
• Danielle West Vandeventer, PH.D.
• Ariel Mary Vandoren, M.A.
• Gabrielle Vanerschelden
• Drayla Vanrachack
• Gary Oscar Vargas, M.D.

• Marriage & Family Therapist in Redwood City, CA
• Providers in Redwood City, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2017; 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.