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General NPI Number Information
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NPI Number | 1356498901
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Entity Type | Individual
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Provider Name | MARY A DEL VECCHIO PSYD, CRC, LPC
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 750 MAIN ST STE 100
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City | SAINT PAUL
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State | MN
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Zip | 55118-3765
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Country | US
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Telephone | 651-233-8036
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Fax | 715-684-6776
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Provider Business Mailing Address
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Address Line | 2536 WILSHIRE CT
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55120-1706
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Country | US
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Telephone | 651-233-8036
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Fax | 715-684-6776
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 235026
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3846-125
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC00915
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MN00915
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License Number State | MN
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