Provider Demographics
NPI:1952527186
Name:DAVEREDE, MARIA E (MS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:DAVEREDE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-1118
Mailing Address - Country:US
Mailing Address - Phone:707-480-6494
Mailing Address - Fax:707-836-0444
Practice Address - Street 1:9940 STARR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-8977
Practice Address - Country:US
Practice Address - Phone:707-837-9962
Practice Address - Fax:707-836-0444
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44630106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist