Provider Demographics
NPI:1184868002
Name:MAGGIO, CATHERINE (MFT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MAGGIO
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 1:1675 TACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1826
Mailing Address - Country:US
Mailing Address - Phone:510-869-4288
Mailing Address - Fax:
Practice Address - Street 1:2711 ALCATRAZ AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2726
Practice Address - Country:US
Practice Address - Phone:510-869-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41940106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist