Provider Demographics
NPI:1972625184
Name:PETRE, MAREN ANITA (MFT)
Entity Type:Individual
Prefix:MS
First Name:MAREN
Middle Name:ANITA
Last Name:PETRE
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 1:344 PLACERVILLE DR
Mailing Address - Street 2:#17
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3920
Mailing Address - Country:US
Mailing Address - Phone:530-621-6345
Mailing Address - Fax:530-622-1293
Practice Address - Street 1:344 PLACERVILLE DR
Practice Address - Street 2:#17
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3920
Practice Address - Country:US
Practice Address - Phone:530-621-6345
Practice Address - Fax:530-622-1293
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33322106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist