Healthcare Provider Details

I. General information

NPI: 1982987996
Provider Name (Legal Business Name): MARY MARGARET WHELLEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 64TH ST 2A
NEW YORK NY
10065-7541
US

IV. Provider business mailing address

423 E 64TH ST 2A
NEW YORK NY
10065-7541
US

V. Phone/Fax

Practice location:
  • Phone: 917-282-5357
  • Fax:
Mailing address:
  • Phone: 917-282-5357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number015780-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: