Healthcare Provider Details

I. General information

NPI: 1376508200
Provider Name (Legal Business Name): MARY PAIGE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2964 FILLMORE ST
SAN FRANCISCO CA
94123-4024
US

IV. Provider business mailing address

239 MONTURA WAY
NOVATO CA
94949-5444
US

V. Phone/Fax

Practice location:
  • Phone: 415-771-8767
  • Fax:
Mailing address:
  • Phone: 415-771-8767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC28004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: