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General NPI Number Information
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NPI Number | 1700325214
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Entity Type | Organization
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Legal Business Name | M. WHARRY, INC.
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 101 N WOODLAND BLVD SUITE 204
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City | DELAND
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State | FL
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Zip | 32720-4245
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Country | US
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Telephone | 386-804-6074
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Fax |
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Provider Business Mailing Address
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Address Line | 102 CEDAR POINT LN
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City | LONGWOOD
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State | FL
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Zip | 32779-4944
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Country | US
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Telephone | 386-804-6074
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY ANN ELIZABETH WHARRY
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Credential | PSY. D.
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Telephone | 386-804-6074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY9476
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License Number State | FL
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