MEDICARE: MARIE NERSESIAN MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	109861	CA
2	106H00000X	Marriage & Family Therapist	119548	CA

General Provider Information

NPI Number	:	1275193674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE NERSESIAN MA

Provider Business Mailing Address
First Line	:	2862 BIGHORN SHEEP ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95407-4557
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 MENDOCINO AVE BLDG C
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2274
Country	:	US
Telephone Number	:	707-284-1978
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	11/22/2024

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Directions to “ MARIE NERSESIAN MA” Practice Location

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