Provider Demographics
NPI:1689866956
Name:SPEIDELL, MARY PATRICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:SPEIDELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6281 YORK MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9358
Mailing Address - Country:US
Mailing Address - Phone:805-543-7851
Mailing Address - Fax:805-237-8331
Practice Address - Street 1:6281 YORK MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9358
Practice Address - Country:US
Practice Address - Phone:805-543-7851
Practice Address - Fax:805-237-8331
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS124981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical