Provider Demographics
NPI:1255427845
Name:SHEETS, MARY HARB (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:HARB
Last Name:SHEETS
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 1:12803 PIMPERNEL WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3603
Mailing Address - Country:US
Mailing Address - Phone:858-484-8332
Mailing Address - Fax:
Practice Address - Street 1:9330 CARMEL MOUNTAIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2157
Practice Address - Country:US
Practice Address - Phone:858-484-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13803103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist