Provider Demographics
NPI:1306178751
Name:SNIDER, MARA E (MA)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:E
Last Name:SNIDER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:ELIZABETH
Other - Last Name:HERRIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1515 ASHFORD RD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-9439
Mailing Address - Country:US
Mailing Address - Phone:707-954-0383
Mailing Address - Fax:
Practice Address - Street 1:934 4TH ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-4001
Practice Address - Country:US
Practice Address - Phone:707-954-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105397101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA105397OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES
CA1306178751Medicaid