Provider Demographics
NPI:1629127493
Name:MEJIA, MARIANNA JANE GABRIEL (MFT)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:JANE GABRIEL
Last Name:MEJIA
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 1:1009 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-9708
Mailing Address - Country:US
Mailing Address - Phone:831-477-2818
Mailing Address - Fax:831-477-2818
Practice Address - Street 1:1009 HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-9708
Practice Address - Country:US
Practice Address - Phone:831-477-2818
Practice Address - Fax:831-477-2818
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist