Provider Demographics
NPI:1619028990
Name:KACERGUIS, MARY ANN (MFT)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:KACERGUIS
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 1:4833 BOXER BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3602
Mailing Address - Country:US
Mailing Address - Phone:925-685-5478
Mailing Address - Fax:
Practice Address - Street 1:2225 BUCHANAN RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4209
Practice Address - Country:US
Practice Address - Phone:925-681-8098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 29097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist