Provider Demographics
NPI:1003264268
Name:TYREE, MARY H (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:H
Last Name:TYREE
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 KETTLES WAY
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-6412
Mailing Address - Country:US
Mailing Address - Phone:518-792-0005
Mailing Address - Fax:
Practice Address - Street 1:53 KETTLES WAY
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-6412
Practice Address - Country:US
Practice Address - Phone:518-792-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-28
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist