Provider Demographics
NPI:1689109696
Name:MAYO, MARK RYAN (PSYD, CA LP 33599)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RYAN
Last Name:MAYO
Suffix:
Gender:M
Credentials:PSYD, CA LP 33599
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 HAIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3505
Mailing Address - Country:US
Mailing Address - Phone:415-310-4047
Mailing Address - Fax:
Practice Address - Street 1:8 BERNICE ST UNIT 107
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4349
Practice Address - Country:US
Practice Address - Phone:415-489-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33599103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist