Provider Demographics
NPI:1871616383
Name:ABZUG, MARISA (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:
Last Name:ABZUG
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 ANDREA LN
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9605
Mailing Address - Country:US
Mailing Address - Phone:831-704-6775
Mailing Address - Fax:877-878-2808
Practice Address - Street 1:730 MISSION ST STE 202
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3689
Practice Address - Country:US
Practice Address - Phone:831-704-6775
Practice Address - Fax:877-878-2808
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44812106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA04181975OtherTHERAPIST