Provider Demographics
NPI:1093042137
Name:BRAUER, MARY ANN (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:BRAUER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:35321 RAMSGATE RD.
Mailing Address - City:THE SEA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:95497-0055
Mailing Address - Country:US
Mailing Address - Phone:707-785-1108
Mailing Address - Fax:
Practice Address - Street 1:35321 RAMSGATE RD.
Practice Address - Street 2:
Practice Address - City:THE SEA RANCH
Practice Address - State:CA
Practice Address - Zip Code:95497
Practice Address - Country:US
Practice Address - Phone:707-785-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 19071106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist