Provider Demographics
NPI:1376646968
Name:KLIMENKO, MARY JULIA E (MFT)
Entity Type:Individual
Prefix:
First Name:MARY JULIA
Middle Name:E
Last Name:KLIMENKO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MARY JULIA
Other - Middle Name:
Other - Last Name:PENDERGAST DECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3 SHOAL DR E
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-6950
Mailing Address - Country:US
Mailing Address - Phone:925-344-3241
Mailing Address - Fax:510-350-9047
Practice Address - Street 1:3 SHOAL DR E
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-6950
Practice Address - Country:US
Practice Address - Phone:707-746-1645
Practice Address - Fax:510-350-9047
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT27292106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist