Provider Demographics
NPI:1376771048
Name:STIEBER, MARYANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:
Last Name:STIEBER
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 1:1020 PROSPECT ST.
Mailing Address - Street 2:STE. 415
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-454-4385
Mailing Address - Fax:858-535-9516
Practice Address - Street 1:1020 PROSPECT ST.
Practice Address - Street 2:STE. 415
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-454-4385
Practice Address - Fax:858-535-9516
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical