Basic Information
| Provider Information | |||||||||
| NPI: | 1316339799 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAWLEY | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | HAWLEY | ||||||||
| OtherFirstName: | CANDICE | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 700 LAUREL AVE | ||||||||
| Address2: | APT. 2B2 | ||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944014176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4844373779 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 375 89TH ST | ||||||||
| Address2: | |||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940151802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503018650 | ||||||||
| FaxNumber: | 6503018639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2015 | ||||||||
| LastUpdateDate: | 03/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.