Provider Demographics
NPI:1124219860
Name:DEVINE, MAUREEN ANN (MFC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ANN
Last Name:DEVINE
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 MENDOCINO AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2221
Mailing Address - Country:US
Mailing Address - Phone:707-542-4502
Mailing Address - Fax:707-579-8755
Practice Address - Street 1:3452 MENDOCINO AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2221
Practice Address - Country:US
Practice Address - Phone:707-542-4502
Practice Address - Fax:707-579-8755
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist