Provider Demographics
NPI:1083779508
Name:TAYLOR SIEBEL, MARY CATHERINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CATHERINE
Last Name:TAYLOR SIEBEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:ROSS
Mailing Address - State:CA
Mailing Address - Zip Code:94957-0036
Mailing Address - Country:US
Mailing Address - Phone:415-455-9572
Mailing Address - Fax:650-755-0410
Practice Address - Street 1:1500 SOUTHGATE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2259
Practice Address - Country:US
Practice Address - Phone:415-455-9572
Practice Address - Fax:650-755-0410
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7821103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY7821OtherPSYCHOLOGY
00PL78210Medicare ID - Type Unspecified