Provider Demographics
NPI:1164722393
Name:MCHANEY, MARY JO (MA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:MCHANEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E SYBELIA AVE
Mailing Address - Street 2:SUITE 165
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4763
Mailing Address - Country:US
Mailing Address - Phone:407-443-3497
Mailing Address - Fax:407-645-4032
Practice Address - Street 1:100 E SYBELIA AVE
Practice Address - Street 2:SUITE 165
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4763
Practice Address - Country:US
Practice Address - Phone:407-443-3497
Practice Address - Fax:407-645-4032
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH883101YM0800X
FLMT648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health