Provider Demographics
NPI:1932716636
Name:MAURER, ALLISSA DENISE
Entity Type:Individual
Prefix:
First Name:ALLISSA
Middle Name:DENISE
Last Name:MAURER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 BRIDGESIDE DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4253
Mailing Address - Country:US
Mailing Address - Phone:209-954-2650
Mailing Address - Fax:
Practice Address - Street 1:9075 ELK GROVE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2072
Practice Address - Country:US
Practice Address - Phone:916-686-9209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-26
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist