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General NPI Number Information
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NPI Number | 1306356969
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Entity Type | Individual
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Provider Name | MARY GRACE ANTONETTE LAVINA ABEAR PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 5200 N LAKE RD
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City | MERCED
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State | CA
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Zip | 95343-5001
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Country | US
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Telephone | 209-228-4266
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1318
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City | SACRAMENTO
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State | CA
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Zip | 95812-1318
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Country | US
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Telephone | 707-315-5406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY35685
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF100848
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License Number State | CA
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