Provider Demographics
NPI:1831205939
Name:PARIS, MARY JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JEAN
Last Name:PARIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:J
Other - Last Name:PARIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:760 MARKET STREET
Mailing Address - Street 2:SUITE 945
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102
Mailing Address - Country:US
Mailing Address - Phone:415-979-8767
Mailing Address - Fax:415-956-9206
Practice Address - Street 1:760 MARKET STREET
Practice Address - Street 2:SUITE 945
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102
Practice Address - Country:US
Practice Address - Phone:415-979-8767
Practice Address - Fax:415-956-9206
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14099103TC0700X
HI687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPL140990Medicare ID - Type Unspecified