Provider Demographics
NPI:1073650503
Name:MASLAN, MARTHA COREY (MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:COREY
Last Name:MASLAN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MRS
Other - First Name:MIMI
Other - Middle Name:COREY
Other - Last Name:MASLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:1223 DRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4802
Mailing Address - Country:US
Mailing Address - Phone:650-344-2221
Mailing Address - Fax:
Practice Address - Street 1:205 E 3RD AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4051
Practice Address - Country:US
Practice Address - Phone:650-242-8097
Practice Address - Fax:866-313-4696
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42666106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80653OtherSAN MATEO COUNTY MEDICAL