Healthcare Provider Details

I. General information

NPI: 1649401092
Provider Name (Legal Business Name): MAREK ONDERA LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WILLOW ST STE 3
MILL VALLEY CA
94941-2895
US

IV. Provider business mailing address

10 WILLOW ST STE 3
MILL VALLEY CA
94941-2895
US

V. Phone/Fax

Practice location:
  • Phone: 415-450-8446
  • Fax:
Mailing address:
  • Phone: 415-450-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 53528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: