Provider Demographics
NPI:1437161510
Name:HUETTEMAN, MARY JOANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOANNE
Last Name:HUETTEMAN
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 1:2660 SOLACE PL STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4337
Mailing Address - Country:US
Mailing Address - Phone:650-302-0159
Mailing Address - Fax:650-306-9323
Practice Address - Street 1:2660 SOLACE PL STE B
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4337
Practice Address - Country:US
Practice Address - Phone:650-302-0159
Practice Address - Fax:650-306-9323
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20640103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical