Provider Demographics
NPI:1235797176
Name:KAGAN, MARCEYA B (MA, AMFT 113319)
Entity Type:Individual
Prefix:
First Name:MARCEYA
Middle Name:B
Last Name:KAGAN
Suffix:
Gender:F
Credentials:MA, AMFT 113319
Other - Prefix:
Other - First Name:BATYA
Other - Middle Name:
Other - Last Name:KAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, AMFT 113319
Mailing Address - Street 1:700 FREDERICK ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2239
Mailing Address - Country:US
Mailing Address - Phone:831-216-8745
Mailing Address - Fax:
Practice Address - Street 1:700 FREDERICK ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2239
Practice Address - Country:US
Practice Address - Phone:831-216-8745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health