Provider Demographics
NPI:1063443448
Name:VANNOY, MARY A (MFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:VANNOY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19033
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92159-0033
Mailing Address - Country:US
Mailing Address - Phone:619-962-2449
Mailing Address - Fax:
Practice Address - Street 1:3435 CAMINO DEL RIO S STE 310
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3912
Practice Address - Country:US
Practice Address - Phone:619-962-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39970106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist