Provider Demographics
NPI:1790157048
Name:MARY J. DEANE, A MARRIAGE AND FAMILY THERAPY CORPORATION
Entity Type:Organization
Organization Name:MARY J. DEANE, A MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-239-5855
Mailing Address - Street 1:1601 DOVE STREET
Mailing Address - Street 2:#230
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1423
Mailing Address - Country:US
Mailing Address - Phone:714-239-5855
Mailing Address - Fax:949-509-6765
Practice Address - Street 1:1601 DOVE ST
Practice Address - Street 2:#230
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2433
Practice Address - Country:US
Practice Address - Phone:714-239-5855
Practice Address - Fax:949-509-6765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT20881251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health