Provider Demographics
NPI:1760691125
Name:NAVARRO, MARY ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:BORATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:800 SANDMANN RD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8592
Mailing Address - Country:US
Mailing Address - Phone:808-346-6784
Mailing Address - Fax:
Practice Address - Street 1:508 H ST STE 9
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3723
Practice Address - Country:US
Practice Address - Phone:808-346-6784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT25343106H00000X
HIMFT 66106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist