Provider Demographics
NPI:1013074137
Name:MAZER, ANDREW (PHD, MFT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MAZER
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1453
Mailing Address - Street 2:
Mailing Address - City:CEDAR RIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95924-1453
Mailing Address - Country:US
Mailing Address - Phone:707-889-0838
Mailing Address - Fax:
Practice Address - Street 1:113 PRESLEY WAY STE 4
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5846
Practice Address - Country:US
Practice Address - Phone:707-889-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36379106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist