Provider Demographics
NPI:1780870352
Name:WEATHERBEE, MARY JANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:WEATHERBEE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 BELLEVUE AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4923
Mailing Address - Country:US
Mailing Address - Phone:510-594-4060
Mailing Address - Fax:
Practice Address - Street 1:445 BELLEVUE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4923
Practice Address - Country:US
Practice Address - Phone:510-594-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 26084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical