Provider Demographics
NPI:1083776652
Name:HARVEY, MARY R (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:R
Last Name:HARVEY
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 1:73 WINTHROP RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4529
Mailing Address - Country:US
Mailing Address - Phone:617-738-0108
Mailing Address - Fax:617-739-0923
Practice Address - Street 1:675 MASSACHUSETTS AVE
Practice Address - Street 2:ELEVENTH FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3309
Practice Address - Country:US
Practice Address - Phone:617-492-3539
Practice Address - Fax:617-739-0923
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3133103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO3255OtherBCBS PROVIDER NUMBER
MA6037OtherUBH PROVIDER NUMBER