Provider Demographics
NPI:1790102978
Name:MOONCOOK, MARI (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARI
Middle Name:
Last Name:MOONCOOK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:JESSE
Other - Middle Name:MARI
Other - Last Name:MOONCOOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,
Mailing Address - Street 1:1301 BROOK PL
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3908
Mailing Address - Country:US
Mailing Address - Phone:650-465-9331
Mailing Address - Fax:650-864-9006
Practice Address - Street 1:1301 BROOK PL
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3908
Practice Address - Country:US
Practice Address - Phone:650-465-9331
Practice Address - Fax:650-864-9006
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health