Provider Demographics
NPI:1598049363
Name:GOESS-SAURAU, MARIE ELIZABETH (BS)
Entity Type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:ELIZABETH
Last Name:GOESS-SAURAU
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 SUNSET LANE
Mailing Address - Street 2:BAART/CDP, ANTIOCH CLINIC
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509
Mailing Address - Country:US
Mailing Address - Phone:925-522-0124
Mailing Address - Fax:925-522-0133
Practice Address - Street 1:3707 SUNSET LANE
Practice Address - Street 2:BAART/CDP, ANTIOCH CLINIC
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509
Practice Address - Country:US
Practice Address - Phone:925-522-0124
Practice Address - Fax:925-522-0133
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)