Provider Demographics
NPI:1083689509
Name:NEBUS, MARY C (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:NEBUS
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 1:32 WINGED FOOT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3999
Mailing Address - Country:US
Mailing Address - Phone:732-740-6389
Mailing Address - Fax:
Practice Address - Street 1:40 AVE AT THE COMMON
Practice Address - Street 2:SUITE 203
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4800
Practice Address - Country:US
Practice Address - Phone:732-740-6389
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3856103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist