Provider Demographics
NPI:1932327392
Name:DEANE, MARY JEANNE (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JEANNE
Last Name:DEANE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PRADO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2612
Mailing Address - Country:US
Mailing Address - Phone:949-509-6765
Mailing Address - Fax:949-509-6765
Practice Address - Street 1:1601 DOVE ST STE 230
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1423
Practice Address - Country:US
Practice Address - Phone:714-239-5855
Practice Address - Fax:949-509-6765
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT20881106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist