Provider Demographics
NPI:1861568081
Name:SAMMARTINO, MARA STEPHANIE LEON
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:STEPHANIE LEON
Last Name:SAMMARTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TEXAS ST STE D
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5700
Mailing Address - Country:US
Mailing Address - Phone:707-639-9158
Mailing Address - Fax:
Practice Address - Street 1:1000 TEXAS ST STE D
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533
Practice Address - Country:US
Practice Address - Phone:707-639-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA701761041C0700X
CA285381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical