Provider Demographics
NPI:1740426311
Name:DVORAK, MARY GENEVIEVE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:GENEVIEVE
Last Name:DVORAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:GENIE
Other - Middle Name:
Other - Last Name:DVORAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1801 BUSH ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5239
Mailing Address - Country:US
Mailing Address - Phone:415-249-9184
Mailing Address - Fax:
Practice Address - Street 1:1801 BUSH ST
Practice Address - Street 2:SUITE 222
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5239
Practice Address - Country:US
Practice Address - Phone:415-249-9184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22952103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist