Provider Demographics
NPI:1962494328
Name:O'TUEL, MARIA (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:O'TUEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:O'TUEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:21545 CENTRE POINTE PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2947
Mailing Address - Country:US
Mailing Address - Phone:661-259-9439
Mailing Address - Fax:
Practice Address - Street 1:21545 CENTRE POINTE PKWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2947
Practice Address - Country:US
Practice Address - Phone:661-259-9439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2694103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000728Medicaid
NC046R4OtherBLUE CROSS BLUE SHIELD
60-00175OtherEVERCARE
60-00175OtherEVERCARE
NC6000728Medicaid