Provider Demographics
NPI:1679645592
Name:MANDZIARA, MARIA V (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:V
Last Name:MANDZIARA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:V
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1397 STUBBLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455
Mailing Address - Country:US
Mailing Address - Phone:805-934-6645
Mailing Address - Fax:
Practice Address - Street 1:105 N. LINCOLN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458
Practice Address - Country:US
Practice Address - Phone:805-928-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)