Provider Demographics
NPI:1316561228
Name:DUFAULT, MAEVE ODILE JACKSON I (AMFT)
Entity type:Individual
Prefix:
First Name:MAEVE
Middle Name:ODILE JACKSON
Last Name:DUFAULT
Suffix:I
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-3902
Mailing Address - Country:US
Mailing Address - Phone:413-429-6094
Mailing Address - Fax:
Practice Address - Street 1:2280 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-3902
Practice Address - Country:US
Practice Address - Phone:413-429-6094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT142397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist