Healthcare Provider Details

I. General information

NPI: 1356773519
Provider Name (Legal Business Name): MARY HENEIN PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 E BIRCH ST STE 206
BREA CA
92821-6267
US

IV. Provider business mailing address

1901 S WOODS CT
LA HABRA CA
90631-9523
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-5015
  • Fax:
Mailing address:
  • Phone: 562-964-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number28834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: