Provider Demographics
NPI:1255437521
Name:LANDES, DOREEN WEISSMAN (MFT)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:WEISSMAN
Last Name:LANDES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 FERNSIDE ST.
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061
Mailing Address - Country:US
Mailing Address - Phone:650-364-4100
Mailing Address - Fax:650-364-4100
Practice Address - Street 1:61 RENATO COURT
Practice Address - Street 2:SUITE 20
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061
Practice Address - Country:US
Practice Address - Phone:650-364-4100
Practice Address - Fax:650-364-4100
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 30878106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist