Provider Demographics
NPI:1144353681
Name:VARON, ELIZABETH (MFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VARON
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 1:1000 BROADWAY STE 460
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4033
Mailing Address - Country:US
Mailing Address - Phone:510-465-5477
Mailing Address - Fax:
Practice Address - Street 1:1000 BROADWAY STE 460
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4033
Practice Address - Country:US
Practice Address - Phone:510-465-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 30717106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist