Provider Demographics
NPI:1669535621
Name:AUSTIN, MARIA DAWN (MMFT, PSY)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:DAWN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MMFT, PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-6019
Mailing Address - Country:US
Mailing Address - Phone:626-742-0897
Mailing Address - Fax:
Practice Address - Street 1:719 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-6019
Practice Address - Country:US
Practice Address - Phone:626-742-0897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33367103TC0700X
CA53666106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist