Provider Demographics
NPI:1134466204
Name:COOMBS, MARY E (LCSW)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:E
Last Name:COOMBS
Suffix:
Gender:F
Credentials:LCSW
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 4704
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-0704
Mailing Address - Country:US
Mailing Address - Phone:801-550-8075
Mailing Address - Fax:
Practice Address - Street 1:3763 HATCHERS CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-3106
Practice Address - Country:US
Practice Address - Phone:209-655-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9781431-3502104100000X
CALCSW1110691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker