Provider Demographics
NPI:1932531092
Name:LUJAN, MAYA (PHD)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:LUJAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:WORLEY-MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 EASTSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3609
Mailing Address - Country:US
Mailing Address - Phone:650-930-0321
Mailing Address - Fax:
Practice Address - Street 1:26 EASTSIDE CIR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3609
Practice Address - Country:US
Practice Address - Phone:707-200-1827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32188103T00000X
TX38034103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist