Provider Demographics
NPI:1861696429
Name:ESTABROOK, MARY ANN
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:ESTABROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:ESTABROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 ESTATES AVE
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1509
Mailing Address - Country:US
Mailing Address - Phone:510-383-1623
Mailing Address - Fax:
Practice Address - Street 1:333 HEGENBERGER RD STE 600
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-1462
Practice Address - Country:US
Practice Address - Phone:510-383-1623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor