Provider Demographics
NPI:1053169821
Name:LAST, NADIA M (AMFT)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:M
Last Name:LAST
Suffix:
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 1:14 MOUNT WITTENBURG CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1058
Mailing Address - Country:US
Mailing Address - Phone:616-901-9625
Mailing Address - Fax:
Practice Address - Street 1:700 E BLITHEDALE AVE STE 2
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1596
Practice Address - Country:US
Practice Address - Phone:415-532-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist