Provider Demographics
NPI:1477523389
Name:MARTIN-BLAIR, MARY (LMFT)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:MARTIN-BLAIR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 CAMINO VERDE CIR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2273
Mailing Address - Country:US
Mailing Address - Phone:925-930-6290
Mailing Address - Fax:925-262-8160
Practice Address - Street 1:2800 PLEASANT HILL RD
Practice Address - Street 2:SUITE 260
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2003
Practice Address - Country:US
Practice Address - Phone:925-930-6290
Practice Address - Fax:925-262-8160
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM17946106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist