Provider Demographics
NPI:1578736021
Name:MABREY, W. GENE (PHD)
Entity Type:Individual
Prefix:MR
First Name:W. GENE
Middle Name:
Last Name:MABREY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 DEDMAN CT
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2424
Mailing Address - Country:US
Mailing Address - Phone:415-613-5183
Mailing Address - Fax:
Practice Address - Street 1:51 DEDMAN CT
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2424
Practice Address - Country:US
Practice Address - Phone:415-613-5183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPYS7760103T00000X
CAPSY7760106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist