Provider Demographics
NPI:1790555779
Name:HUNDRIESER, MARA L (MA)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:L
Last Name:HUNDRIESER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:LEE
Other - Last Name:ACOSTA MURILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:372 E EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3708
Mailing Address - Country:US
Mailing Address - Phone:619-454-9060
Mailing Address - Fax:
Practice Address - Street 1:6232 N PULASKI RD STE 400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5133
Practice Address - Country:US
Practice Address - Phone:312-725-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health