Provider Demographics
NPI:1710735386
Name:ANIASCO, MARIAH (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:ANIASCO
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 761 1275 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366
Mailing Address - Country:US
Mailing Address - Phone:209-969-5317
Mailing Address - Fax:
Practice Address - Street 1:1359 TANNEHILL DR
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-8036
Practice Address - Country:US
Practice Address - Phone:209-969-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11723101YM0800X
CA133185106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health