Provider Demographics
NPI:1548312689
Name:MARON, WENDY E (MA)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:E
Last Name:MARON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805
Mailing Address - Country:US
Mailing Address - Phone:510-233-0998
Mailing Address - Fax:510-233-8587
Practice Address - Street 1:630 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805
Practice Address - Country:US
Practice Address - Phone:510-233-0998
Practice Address - Fax:510-233-8587
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 13123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist