Provider Demographics
NPI:1962169797
Name:CONTARDI, MAYA
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:CONTARDI
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 1:763 BELGLEN WAY
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-5013
Mailing Address - Country:US
Mailing Address - Phone:707-294-9276
Mailing Address - Fax:
Practice Address - Street 1:2400 COUNTY CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3004
Practice Address - Country:US
Practice Address - Phone:707-566-0170
Practice Address - Fax:707-568-5445
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1417168949Medicaid