Provider Demographics
NPI:1316031834
Name:LAWLER, MARY JO
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:LAWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JO
Other - Last Name:RUSHING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:P.O. BOX 723067
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92172-3067
Mailing Address - Country:US
Mailing Address - Phone:760-436-7107
Mailing Address - Fax:858-538-6814
Practice Address - Street 1:741 GARDENVIEW COURT
Practice Address - Street 2:SUITE 210
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-436-7107
Practice Address - Fax:858-538-6814
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA015598106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist