Provider Demographics
NPI:1083701841
Name:JONAS, MARY LEE (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LEE
Last Name:JONAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LEE
Other - Last Name:SZCZEPANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2391 SOUTHWEST 180 AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029
Mailing Address - Country:US
Mailing Address - Phone:954-438-2852
Mailing Address - Fax:954-443-0027
Practice Address - Street 1:1730 MAIN STREET
Practice Address - Street 2:SUITE 222
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326
Practice Address - Country:US
Practice Address - Phone:954-385-0353
Practice Address - Fax:954-389-0886
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3726101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor