Provider Demographics
NPI:1760410179
Name:GONZALEZ-HUSS, MARY JANE (PHD)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:GONZALEZ-HUSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAPLE ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3249
Mailing Address - Country:US
Mailing Address - Phone:831-751-3459
Mailing Address - Fax:831-751-6435
Practice Address - Street 1:11 MAPLE ST
Practice Address - Street 2:SUITE F
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3249
Practice Address - Country:US
Practice Address - Phone:831-751-3459
Practice Address - Fax:831-751-6435
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9639103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL96390Medicare ID - Type Unspecified