Provider Demographics
NPI:1477972057
Name:PRUTTON, MARIANA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:PRUTTON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 MISSION ST # 311
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4501
Mailing Address - Country:US
Mailing Address - Phone:415-963-4149
Mailing Address - Fax:
Practice Address - Street 1:3041 MISSION ST # 311
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4501
Practice Address - Country:US
Practice Address - Phone:415-963-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105661106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist