Provider Demographics
NPI:1912376724
Name:HEFFERNAN, MARIA (MFT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 W MARCH LN
Mailing Address - Street 2:STE 210
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8211
Mailing Address - Country:US
Mailing Address - Phone:209-957-2676
Mailing Address - Fax:209-957-2587
Practice Address - Street 1:2431 W MARCH LN
Practice Address - Street 2:STE 210
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8211
Practice Address - Country:US
Practice Address - Phone:209-957-2676
Practice Address - Fax:209-957-2587
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT20104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health