Provider Demographics
NPI:1649322298
Name:BOLLO MAROON, RENEE (MFT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BOLLO MAROON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:BOLLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:3565 HAGEN RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3849
Mailing Address - Country:US
Mailing Address - Phone:650-520-0349
Mailing Address - Fax:
Practice Address - Street 1:3565 HAGEN RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3849
Practice Address - Country:US
Practice Address - Phone:650-520-0349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33849103T00000X, 103TA0400X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)