Provider Demographics
NPI:1205381951
Name:INTAGLIATA, MARC (LISCENSED MFT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:INTAGLIATA
Suffix:
Gender:M
Credentials:LISCENSED MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 TARA RD
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3116
Mailing Address - Country:US
Mailing Address - Phone:773-505-1775
Mailing Address - Fax:
Practice Address - Street 1:57 TARA RD
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3116
Practice Address - Country:US
Practice Address - Phone:773-505-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist