Provider Demographics
NPI:1013565985
Name:ZACARIAS, MARCO ANTONIO (AMFT)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:ANTONIO
Last Name:ZACARIAS
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E TRAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3958
Mailing Address - Country:US
Mailing Address - Phone:920-509-2099
Mailing Address - Fax:
Practice Address - Street 1:345 E TRAVIS BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3958
Practice Address - Country:US
Practice Address - Phone:920-509-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist