Provider Demographics
NPI:1801006952
Name:D'ONOFRIO, MARYANN JACQUELINE (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:JACQUELINE
Last Name:D'ONOFRIO
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1618
Mailing Address - Country:US
Mailing Address - Phone:510-268-7837
Mailing Address - Fax:510-451-4703
Practice Address - Street 1:568 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1618
Practice Address - Country:US
Practice Address - Phone:510-268-7837
Practice Address - Fax:510-451-4703
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14974103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical