Provider Demographics
NPI:1831314764
Name:MCNAMEE, MARI LYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARI
Middle Name:LYN
Last Name:MCNAMEE
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 1:30011 IVY GLENN
Mailing Address - Street 2:STE 205
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-206-4465
Mailing Address - Fax:949-673-2218
Practice Address - Street 1:30011 IVY GLENN
Practice Address - Street 2:STE 205
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-206-4465
Practice Address - Fax:949-673-2218
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11545Medicare UPIN