Provider Demographics
NPI:1053965889
Name:RUFAEL, MARIYAM-IFTEAM Y (AMFT)
Entity type:Individual
Prefix:
First Name:MARIYAM-IFTEAM
Middle Name:Y
Last Name:RUFAEL
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 1:7022 STOCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2949
Mailing Address - Country:US
Mailing Address - Phone:510-570-7779
Mailing Address - Fax:
Practice Address - Street 1:2526 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2607
Practice Address - Country:US
Practice Address - Phone:510-467-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150068106H00000X
CA109977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist