Provider Demographics
NPI:1699089441
Name:ALUMBAUGH, MARY JANE (PHD)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:ALUMBAUGH
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 1:301 E COOK ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5133
Mailing Address - Country:US
Mailing Address - Phone:805-614-0094
Mailing Address - Fax:805-980-4432
Practice Address - Street 1:301 E COOK ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5133
Practice Address - Country:US
Practice Address - Phone:805-614-0094
Practice Address - Fax:805-980-4432
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10031103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical