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General NPI Number Information
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NPI Number | 1811937717
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Entity Type | Individual
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Provider Name | MARY JANE ANDERSON-WILEY PH.D., LMHC
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 349 OLD PLYMOUTH ROAD
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City | SAGAMORE BEACH
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State | MA
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Zip | 02562-2367
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Country | US
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Telephone | 706-627-7770
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Fax | 508-213-3673
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Provider Business Mailing Address
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Address Line | 9 ROUNDHOUSE ROAD
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City | BUZZARDS BAY
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State | MA
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Zip | 02532-3873
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Country | US
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Telephone | 706-627-7770
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Fax | 508-213-3673
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 9038
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License Number State | MA
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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 | 9038
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 9038
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 9038
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License Number State | MA
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