Provider Demographics
NPI:1053817064
Name:LEAL, MARIAH NICOLE
Entity Type:Individual
Prefix:MS
First Name:MARIAH
Middle Name:NICOLE
Last Name:LEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 JEFFERSON ST STE C
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1746
Mailing Address - Country:US
Mailing Address - Phone:707-227-4448
Mailing Address - Fax:
Practice Address - Street 1:1734 JEFFERSON ST STE C
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1746
Practice Address - Country:US
Practice Address - Phone:707-227-4448
Practice Address - Fax:707-635-8215
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health