Provider Demographics
NPI:1346465648
Name:MAYER, CONSTANCE ELIZABETH (MS, MFT)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:ELIZABETH
Last Name:MAYER
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ANNABEL LN STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4358
Mailing Address - Country:US
Mailing Address - Phone:925-327-0014
Mailing Address - Fax:
Practice Address - Street 1:1 ANNABEL LN STE 107
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4358
Practice Address - Country:US
Practice Address - Phone:925-327-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 22340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist