MEDICARE: DR. MARY B MCRAE ED.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	010051-1	NY

General Provider Information

NPI Number	:	1417282161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY B MCRAE ED.D

Provider Business Mailing Address
First Line	:	215 W 88TH ST APT 1B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-2324
Country	:	US
Telephone Number	:	212-678-7193
Fax Number	:	212-678-7193

Provider Business Practice Location Address
First Line	:	215 W 88TH ST APT 1B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-2324
Country	:	US
Telephone Number	:	212-678-7193
Fax Number	:	212-678-7193

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	10/14/2009

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