Provider Demographics
NPI:1124222039
Name:DONNELLY-DEBAY, MARY ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:DONNELLY-DEBAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-4429
Mailing Address - Country:US
Mailing Address - Phone:802-434-6773
Mailing Address - Fax:
Practice Address - Street 1:80 NORMAND ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1339
Practice Address - Country:US
Practice Address - Phone:802-655-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000750103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical