MEDICARE: DR. MARIE E HANEY PSYD

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	103T00000X	Psychologist	3928	CO

General Provider Information

NPI Number	:	1790362440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE E HANEY PSYD

Provider Business Mailing Address
First Line	:	145 WILD GRASS WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3778
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 WILD GRASS WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3778
Country	:	US
Telephone Number	:	719-641-3236
Fax Number	:

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

Provider Enumeration Date	:	03/27/2021
Last Update Date	:	03/27/2021

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