Healthcare Provider Details

I. General information

NPI: 1720432412
Provider Name (Legal Business Name): MARY A CHENEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAIN ST # 8
WATERTOWN CT
06779-1705
US

IV. Provider business mailing address

240 KENT RD
WARREN CT
06754-1607
US

V. Phone/Fax

Practice location:
  • Phone: 203-415-8066
  • Fax: 860-799-4156
Mailing address:
  • Phone: 203-415-8066
  • Fax: 860-799-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number002049
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: