Provider Demographics
NPI:1609310143
Name:LAMA, MARY (MFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LAMA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 OLD BERNAL AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7015
Mailing Address - Country:US
Mailing Address - Phone:925-399-1636
Mailing Address - Fax:
Practice Address - Street 1:231 OLD BERNAL AVE
Practice Address - Street 2:SUITE 5A
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7015
Practice Address - Country:US
Practice Address - Phone:925-399-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist