Healthcare Provider Details

I. General information

NPI: 1811102908
Provider Name (Legal Business Name): MARY ANN BARR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 CASCADE DR
MILL VALLEY CA
94941-5025
US

IV. Provider business mailing address

277 CASCADE DR
MILL VALLEY CA
94941-5025
US

V. Phone/Fax

Practice location:
  • Phone: 415-383-9245
  • Fax: 415-389-0396
Mailing address:
  • Phone: 415-383-9245
  • Fax: 415-389-0396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberPG 5913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: