Provider Demographics
NPI:1508232612
Name:VIERRA, NANCY (MS, MFT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:VIERRA
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 1:35 GERTRUDE LN
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-2861
Mailing Address - Country:US
Mailing Address - Phone:628-587-1539
Mailing Address - Fax:
Practice Address - Street 1:35 GERTRUDE LN
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-2861
Practice Address - Country:US
Practice Address - Phone:628-587-1539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107199106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist