Provider Demographics
NPI:1619175668
Name:SEEVERS, MARY DEGER (MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DEGER
Last Name:SEEVERS
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S AMPHLETT BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2702
Mailing Address - Country:US
Mailing Address - Phone:650-655-2718
Mailing Address - Fax:
Practice Address - Street 1:1720 S AMPHLETT BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2702
Practice Address - Country:US
Practice Address - Phone:650-655-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist