Provider Demographics
NPI:1003160110
Name:MAYO, JEANNE FELICIA (MFT, LMFT)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:FELICIA
Last Name:MAYO
Suffix:
Gender:F
Credentials:MFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 BALTIMORE PIKE
Mailing Address - Street 2:BLDG. 200, SUITE 250
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3958
Mailing Address - Country:US
Mailing Address - Phone:610-544-2110
Mailing Address - Fax:610-604-9510
Practice Address - Street 1:103 MONT BLANC BLVD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7615
Practice Address - Country:US
Practice Address - Phone:302-678-3020
Practice Address - Fax:302-678-2458
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000584106H00000X
DEFT-0000046106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist