Provider Demographics
NPI:1700279411
Name:LEFEVRE, MARY KATHRYN (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:LEFEVRE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHRYN
Other - Last Name:MARTINDALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1425 BROADWAY STE 14
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3435
Mailing Address - Country:US
Mailing Address - Phone:510-499-2160
Mailing Address - Fax:
Practice Address - Street 1:1425 BROADWAY STE 14
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3435
Practice Address - Country:US
Practice Address - Phone:510-499-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41957106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist