Provider Demographics
NPI:1679173843
Name:FERRAES, MAIDA PATRICIA (LMFT)
Entity type:Individual
Prefix:
First Name:MAIDA
Middle Name:PATRICIA
Last Name:FERRAES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17901 MARK LEE DR
Mailing Address - Street 2:
Mailing Address - City:JAMUL
Mailing Address - State:CA
Mailing Address - Zip Code:91935-2649
Mailing Address - Country:US
Mailing Address - Phone:760-554-7455
Mailing Address - Fax:
Practice Address - Street 1:17901 MARK LEE DR
Practice Address - Street 2:
Practice Address - City:JAMUL
Practice Address - State:CA
Practice Address - Zip Code:91935-2649
Practice Address - Country:US
Practice Address - Phone:760-554-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty