Provider Demographics
NPI:1962005165
Name:MERTZ, MARGAUX MARTINE (RADT)
Entity Type:Individual
Prefix:
First Name:MARGAUX
Middle Name:MARTINE
Last Name:MERTZ
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2793 SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-4632
Mailing Address - Country:US
Mailing Address - Phone:707-363-7692
Mailing Address - Fax:
Practice Address - Street 1:508 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4446
Practice Address - Country:US
Practice Address - Phone:707-515-7186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAR1397910720101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)