Provider Demographics
NPI:1063858017
Name:AMELIA, MARY E (MA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:AMELIA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PONDFIELD RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3784
Mailing Address - Country:US
Mailing Address - Phone:914-968-9008
Mailing Address - Fax:
Practice Address - Street 1:7 PONDFIELD RD
Practice Address - Street 2:SUITE 208
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3784
Practice Address - Country:US
Practice Address - Phone:914-968-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06-001192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist