Provider Demographics
NPI:1083844062
Name:MAREK, KATHLEEN CAMPION (MA, MFT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CAMPION
Last Name:MAREK
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 1:415 CAMBRIDGE AVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1600
Mailing Address - Country:US
Mailing Address - Phone:408-792-0289
Mailing Address - Fax:
Practice Address - Street 1:415 CAMBRIDGE AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1600
Practice Address - Country:US
Practice Address - Phone:408-792-0289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT39627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist