Provider Demographics
NPI:1417000340
Name:IVERSEN, MAUREEN
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:IVERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 KEYES CT
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-4123
Mailing Address - Country:US
Mailing Address - Phone:707-429-2110
Mailing Address - Fax:
Practice Address - Street 1:201 E ALASKA AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533
Practice Address - Country:US
Practice Address - Phone:707-644-0485
Practice Address - Fax:650-573-2110
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor