Provider Demographics
NPI:1780881938
Name:ZIADEH, MARY S (LMFT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:S
Last Name:ZIADEH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 TRANCAS ST UNIT 2216
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-7705
Mailing Address - Country:US
Mailing Address - Phone:310-734-0593
Mailing Address - Fax:707-341-3725
Practice Address - Street 1:1625 TRANCAS ST UNIT 2216
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-7705
Practice Address - Country:US
Practice Address - Phone:310-734-0593
Practice Address - Fax:707-341-3725
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2024-10-01
Deactivation Date:2012-01-25
Deactivation Code:
Reactivation Date:2016-12-15
Provider Licenses
StateLicense IDTaxonomies
CA111120106H00000X, 106H00000X
CA97072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist