Healthcare Provider Details

I. General information

NPI: 1710930367
Provider Name (Legal Business Name): MARY ATWOOD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date: 08/28/2007
Reactivation Date: 11/20/2007

III. Provider practice location address

4070 OAKHURST DR
SARASOTA FL
34233-1444
US

IV. Provider business mailing address

4070 OAKHURST DR
SARASOTA FL
34233-1444
US

V. Phone/Fax

Practice location:
  • Phone: 941-487-7890
  • Fax:
Mailing address:
  • Phone: 941-487-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY8128
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number550
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: