Provider Demographics
NPI:1215645544
Name:LANDAU, FLORENCE (MA MFT)
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:
Last Name:LANDAU
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:PENNGROVE
Mailing Address - State:CA
Mailing Address - Zip Code:94951-9602
Mailing Address - Country:US
Mailing Address - Phone:415-845-4889
Mailing Address - Fax:
Practice Address - Street 1:305 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:PENNGROVE
Practice Address - State:CA
Practice Address - Zip Code:94951-9602
Practice Address - Country:US
Practice Address - Phone:415-845-4889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 221700000X
CA41036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist