Provider Demographics
NPI:1356578157
Name:SERRANO, MARY ANN (MA, MFT INTERN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:SERRANO
Suffix:
Gender:F
Credentials:MA, MFT INTERN
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:GUNDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3006
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-1006
Mailing Address - Country:US
Mailing Address - Phone:408-391-4182
Mailing Address - Fax:
Practice Address - Street 1:232 E GISH RD
Practice Address - Street 2:EMQFF
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4706
Practice Address - Country:US
Practice Address - Phone:408-391-4182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 56663106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist