Provider Demographics
NPI:1982804514
Name:STEIN, MARY ELIZABETH (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:STEIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:BOKANICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:855 MAIN ST
Mailing Address - Street 2:#208
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6668
Mailing Address - Country:US
Mailing Address - Phone:925-819-2496
Mailing Address - Fax:925-447-3909
Practice Address - Street 1:855 MAIN ST
Practice Address - Street 2:#208
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6668
Practice Address - Country:US
Practice Address - Phone:925-819-2496
Practice Address - Fax:925-447-3909
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-22
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35416106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist