Provider Demographics
NPI:1114297736
Name:NOGUEIRA DE ANDRADE, MARIANA
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:NOGUEIRA DE ANDRADE
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 1:719 2ND ST STE 8
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4666
Mailing Address - Country:US
Mailing Address - Phone:408-416-1710
Mailing Address - Fax:530-231-0128
Practice Address - Street 1:719 2ND ST STE 8
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4666
Practice Address - Country:US
Practice Address - Phone:408-416-1710
Practice Address - Fax:530-231-0128
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor