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General NPI Number Information
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NPI Number | 1013074137
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Entity Type | Individual
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Provider Name | ANDREW MAZER PHD, MFT
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 113 PRESLEY WAY STE 4
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5846
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Country | US
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Telephone | 707-889-0838
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1453
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City | CEDAR RIDGE
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State | CA
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Zip | 95924-1453
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Country | US
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Telephone | 707-889-0838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC36379
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License Number State | CA
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