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General NPI Number Information
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NPI Number | 1679250856
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Entity Type | Individual
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Provider Name | COENITA MARIE ST MARY
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Gender | Female
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 600 BERCUT DR
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City | SACRAMENTO
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State | CA
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Zip | 95811-0131
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Country | US
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Telephone | 916-440-1500
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Fax | 916-440-1514
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Provider Business Mailing Address
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Address Line | 3841 N FREEWAY BLVD STE 245
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City | SACRAMENTO
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State | CA
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Zip | 95834-1969
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Country | US
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Telephone | 916-441-0226
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Fax | 916-441-0286
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW133861
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License Number State | CA
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