Provider Demographics
NPI:1740315613
Name:CHAVEZ-GEREDA, MARIANA (LMFT)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:CHAVEZ-GEREDA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT90484
Mailing Address - Street 1:3958 CASTRO VALLEY BLVD APT 23
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-6028
Mailing Address - Country:US
Mailing Address - Phone:510-695-8769
Mailing Address - Fax:
Practice Address - Street 1:154 SANTA CLARA AVE STE 7
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1323
Practice Address - Country:US
Practice Address - Phone:106-958-7695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CALMFT 90484106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor