Provider Demographics
NPI:1215945100
Name:CARTER, MARIANNE E (MFT RN)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:E
Last Name:CARTER
Suffix:
Gender:F
Credentials:MFT RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 MOORPARK AVE
Mailing Address - Street 2:#270
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-296-0979
Mailing Address - Fax:408-364-1768
Practice Address - Street 1:2901 MOORPARK AVE
Practice Address - Street 2:#270
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-296-0979
Practice Address - Fax:408-364-1768
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT27070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist