Provider Demographics
NPI:1982819603
Name:MARAN, ELEANOR (MSW)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:MARAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ELLY
Other - Middle Name:
Other - Last Name:MARAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:480 ALPINE LANE
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5514
Mailing Address - Country:US
Mailing Address - Phone:209-588-8575
Mailing Address - Fax:
Practice Address - Street 1:480 ALPINE LANE
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5514
Practice Address - Country:US
Practice Address - Phone:209-588-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS69041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17943ZMedicare ID - Type Unspecified