Provider Demographics
NPI:1356473763
Name:WILEY, MARY OLEARY (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:OLEARY
Last Name:WILEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 BURGOON ROAD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-1715
Mailing Address - Country:US
Mailing Address - Phone:814-942-4045
Mailing Address - Fax:814-944-0419
Practice Address - Street 1:3701 BURGOON ROAD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1715
Practice Address - Country:US
Practice Address - Phone:814-942-4045
Practice Address - Fax:814-944-0419
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008198L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA547426000OtherHIGHMARK
PA000897SFFMedicare PIN