MEDICARE: DR. MARY ANNE ARDITO PSYD MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	MFC21205	CA

General Provider Information

NPI Number	:	1194781120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ANNE ARDITO PSYD MFT

Provider Business Mailing Address
First Line	:	1440 N HARBOR BLVD
Second Line	:	STE 800
City	:	FULLERTON
State	:	CA
Zip	:	92835-4127
Country	:	US
Telephone Number	:	714-680-0631
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 N HARBOR BLVD
Second Line	:	STE 800
City	:	FULLERTON
State	:	CA
Zip	:	92835-4127
Country	:	US
Telephone Number	:	714-680-0631
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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