Provider Demographics
NPI:1306356969
Name:ABEAR, MARY GRACE ANTONETTE LAVINA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY GRACE ANTONETTE
Middle Name:LAVINA
Last Name:ABEAR
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:PO BOX 1318
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95812-1318
Mailing Address - Country:US
Mailing Address - Phone:707-315-5406
Mailing Address - Fax:
Practice Address - Street 1:5200 N LAKE RD
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95343-5001
Practice Address - Country:US
Practice Address - Phone:209-228-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2025-05-05
Deactivation Date:2017-10-11
Deactivation Code:
Reactivation Date:2017-10-18
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CAPSY35685103TC0700X
CAIMF100848106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist