Healthcare Provider Details

I. General information

NPI: 1306970371
Provider Name (Legal Business Name): MARY BRIANA HUARTE PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY BRIANA HOGAN M.A.

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 BUTANO DRIVE SUITE 109
SACRAMENTO CA
95825
US

IV. Provider business mailing address

2322 BUTANO DRIVE SUITE 109
SACRAMENTO CA
95825
US

V. Phone/Fax

Practice location:
  • Phone: 916-572-1298
  • Fax:
Mailing address:
  • Phone: 916-572-1298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberNPI1306970371
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: