Provider Demographics
NPI:1457999781
Name:HINSDALE, MARY DENISE (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DENISE
Last Name:HINSDALE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PLEASANT HILL AVE N STE 370
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3169
Mailing Address - Country:US
Mailing Address - Phone:707-595-3487
Mailing Address - Fax:
Practice Address - Street 1:120 PLEASANT HILL AVE N STE 370
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3169
Practice Address - Country:US
Practice Address - Phone:707-595-3487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM15347106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist