Provider Demographics
NPI:1295758209
Name:MAZER, MARILYN (LMFT)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:MAZER
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 1:610 D ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3708
Mailing Address - Country:US
Mailing Address - Phone:415-419-3565
Mailing Address - Fax:415-383-0865
Practice Address - Street 1:610 D ST
Practice Address - Street 2:SUITE D
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3708
Practice Address - Country:US
Practice Address - Phone:415-419-3565
Practice Address - Fax:415-383-0865
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health