Provider Demographics
NPI:1295026169
Name:HALLADAY, MARY J (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:HALLADAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7804 HARDWICK PL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1429
Mailing Address - Country:US
Mailing Address - Phone:317-612-4484
Mailing Address - Fax:
Practice Address - Street 1:7804 HARDWICK PL
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1429
Practice Address - Country:US
Practice Address - Phone:317-612-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003943A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical