Provider Demographics
NPI:1346410750
Name:HEALY, MARYETTA T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARYETTA
Middle Name:T
Last Name:HEALY
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 1:11911 NE 1ST STREET, SUITE 206
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3032
Mailing Address - Country:US
Mailing Address - Phone:425-453-7890
Mailing Address - Fax:877-879-3041
Practice Address - Street 1:11911 NE 1ST STREET, SUITE 206
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3032
Practice Address - Country:US
Practice Address - Phone:425-453-7890
Practice Address - Fax:877-879-3041
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003827103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist