Provider Demographics
NPI:1598822066
Name:GARNETT, MARY JO P (MS LMFT)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:P
Last Name:GARNETT
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:MARY JO
Other - Middle Name:P
Other - Last Name:SICURO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7439 LA PALMA AVENUE
Mailing Address - Street 2:PMB #251
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90120-2655
Mailing Address - Country:US
Mailing Address - Phone:714-722-1059
Mailing Address - Fax:714-952-2093
Practice Address - Street 1:2024 W LINCOLN AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-772-1059
Practice Address - Fax:714-952-2093
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA#LMFT19440103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist