Provider Demographics
NPI:1073993093
Name:BARON, MARY (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BARON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 W ANTHEM WAY
Mailing Address - Street 2:145
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0430
Mailing Address - Country:US
Mailing Address - Phone:480-818-1979
Mailing Address - Fax:
Practice Address - Street 1:3655 W ANTHEM WAY
Practice Address - Street 2:145
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0430
Practice Address - Country:US
Practice Address - Phone:480-818-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ152103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling