Provider Demographics
NPI:1427381938
Name:CAFFERY, MAGGIE
Entity Type:Individual
Prefix:MS
First Name:MAGGIE
Middle Name:
Last Name:CAFFERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14222
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95402-6222
Mailing Address - Country:US
Mailing Address - Phone:707-342-5662
Mailing Address - Fax:707-540-6095
Practice Address - Street 1:862 3RD ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-342-5662
Practice Address - Fax:707-540-5662
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA63943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427381938OtherBEACON HEALTH STRATEGIES (MEDICAL)