MEDICARE: MARY JO MCHANEY M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH883	FL
2	106H00000X	Marriage & Family Therapist	MT648	FL

General Provider Information

NPI Number	:	1164722393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JO MCHANEY M.A.

Provider Business Mailing Address
First Line	:	100 E SYBELIA AVE
Second Line	:	SUITE 165
City	:	MAITLAND
State	:	FL
Zip	:	32751-4763
Country	:	US
Telephone Number	:	407-443-3497
Fax Number	:	407-645-4032

Provider Business Practice Location Address
First Line	:	100 E SYBELIA AVE
Second Line	:	SUITE 165
City	:	MAITLAND
State	:	FL
Zip	:	32751-4763
Country	:	US
Telephone Number	:	407-443-3497
Fax Number	:	407-645-4032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	10/21/2010

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