Provider Demographics
NPI:1891006193
Name:STIEFVATER, MARINA (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:STIEFVATER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 BROADWAY
Mailing Address - Street 2:STE. E-2
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-7445
Mailing Address - Country:US
Mailing Address - Phone:707-529-8153
Mailing Address - Fax:
Practice Address - Street 1:1055 BROADWAY STE D
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-7467
Practice Address - Country:US
Practice Address - Phone:707-996-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist