Provider Demographics
NPI:1093297509
Name:MARON, ADELINE REINE
Entity Type:Individual
Prefix:
First Name:ADELINE
Middle Name:REINE
Last Name:MARON
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 1:2033 FRUITVALE CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-8935
Mailing Address - Country:US
Mailing Address - Phone:925-518-7702
Mailing Address - Fax:
Practice Address - Street 1:2033 FRUITVALE CT
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-8935
Practice Address - Country:US
Practice Address - Phone:925-518-7702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst