Provider Demographics
NPI:1568967768
Name:MIERZEJEWSKI, PAULA F (LMFT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:F
Last Name:MIERZEJEWSKI
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 1:361 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1814
Mailing Address - Country:US
Mailing Address - Phone:415-453-4037
Mailing Address - Fax:
Practice Address - Street 1:710 C ST STE 9
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3853
Practice Address - Country:US
Practice Address - Phone:415-491-4705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist