Provider Demographics
NPI:1124235593
Name:WARD, MARIJANE ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIJANE
Middle Name:ELIZABETH
Last Name:WARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 CANTO NUBIADO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6420
Mailing Address - Country:US
Mailing Address - Phone:949-388-3741
Mailing Address - Fax:
Practice Address - Street 1:2801 CANTO NUBIADO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6420
Practice Address - Country:US
Practice Address - Phone:949-388-3741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16623103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical