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NPI Code Detail

MEDICARE: MISS MARY HER PSY.D.

MEDICARE: MISS MARY HER PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSB94020661CA

General Provider Information

NPI Number : 1063769909
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MARY HER PSY.D.
Provider Business Mailing Address
First Line : 1960 N GATEWAY BLVD
Second Line :
City : FRESNO
State : CA
Zip : 93727-1604
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1960 N GATEWAY BLVD
Second Line :
City : FRESNO
State : CA
Zip : 93727-1604
Country : US
Telephone Number : 559-266-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2012
Last Update Date : 04/29/2021

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Directions to “ MISS MARY HER PSY.D.” Practice Location

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