Provider Demographics
NPI:1538382882
Name:BOLIARIS, MARINA ALBINE (MFT)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:ALBINE
Last Name:BOLIARIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 BERNAL RD
Mailing Address - Street 2:140
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1343
Mailing Address - Country:US
Mailing Address - Phone:408-363-4842
Mailing Address - Fax:408-972-6494
Practice Address - Street 1:175 BERNAL RD
Practice Address - Street 2:140
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1343
Practice Address - Country:US
Practice Address - Phone:408-363-4842
Practice Address - Fax:408-972-6494
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 27698106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist