Provider Demographics
NPI:1255536769
Name:PURCELL, MARK C (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:PURCELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 PARKVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1528
Mailing Address - Country:US
Mailing Address - Phone:415-571-7189
Mailing Address - Fax:
Practice Address - Street 1:644 PARKVIEW CIR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1528
Practice Address - Country:US
Practice Address - Phone:415-571-7189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist