Healthcare Provider Details

I. General information

NPI: 1609450220
Provider Name (Legal Business Name): MAREN WRAY MASSEY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 ALHAMBRA BLVD STE 200
SACRAMENTO CA
95816-6543
US

IV. Provider business mailing address

420 CHELAN DR
VACAVILLE CA
95687-4911
US

V. Phone/Fax

Practice location:
  • Phone: 916-780-1059
  • Fax:
Mailing address:
  • Phone: 707-225-7454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number124934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: