Provider Demographics
NPI:1326125998
Name:WOLLITZ DOOLEY, MARY (PHD HSPP)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:WOLLITZ DOOLEY
Suffix:
Gender:F
Credentials:PHD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-0616
Mailing Address - Country:US
Mailing Address - Phone:317-201-6813
Mailing Address - Fax:317-839-3117
Practice Address - Street 1:7125 E US HWY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123
Practice Address - Country:US
Practice Address - Phone:317-272-2190
Practice Address - Fax:317-272-2199
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040167A103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
345560Medicare ID - Type Unspecified