Provider Demographics
NPI:1942300504
Name:WILEY, MARY CALLAWAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CALLAWAY
Last Name:WILEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 RAINBOW CIR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4428
Mailing Address - Country:US
Mailing Address - Phone:925-381-3839
Mailing Address - Fax:925-736-8016
Practice Address - Street 1:145 EAST PROSPECT AVENUE
Practice Address - Street 2:SUITE 215D
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526
Practice Address - Country:US
Practice Address - Phone:925-901-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18822103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist