Provider Demographics
NPI:1295853695
Name:HUBBARD, MARY CHRISTINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CHRISTINE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 ROSARIO CIR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3915
Mailing Address - Country:US
Mailing Address - Phone:714-345-0685
Mailing Address - Fax:
Practice Address - Street 1:1313 ROSARIO CIR
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3915
Practice Address - Country:US
Practice Address - Phone:714-345-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical