Provider Demographics
NPI:1659500171
Name:THOMAS, MARY DIANNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DIANNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 BOREL PLACE
Mailing Address - Street 2:SUITE 509
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2851
Mailing Address - Country:US
Mailing Address - Phone:650-349-3903
Mailing Address - Fax:650-570-7779
Practice Address - Street 1:1777 BOREL PLACE
Practice Address - Street 2:SUITE 509
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2851
Practice Address - Country:US
Practice Address - Phone:650-349-0461
Practice Address - Fax:650-570-7779
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25893101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health