Provider Demographics
NPI:1952999724
Name:RODELANDER, MAYA (AMFT)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:RODELANDER
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 MCALLISTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-4422
Mailing Address - Country:US
Mailing Address - Phone:619-550-7815
Mailing Address - Fax:
Practice Address - Street 1:30 N SAN PEDRO RD STE 290
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4133
Practice Address - Country:US
Practice Address - Phone:415-300-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT122645106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist