Provider Demographics
NPI:1356493837
Name:LANEY, MARY D (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:D
Last Name:LANEY
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 1:296 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2471
Mailing Address - Country:US
Mailing Address - Phone:732-548-4149
Mailing Address - Fax:732-246-7696
Practice Address - Street 1:296 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2471
Practice Address - Country:US
Practice Address - Phone:732-548-4149
Practice Address - Fax:732-246-7696
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2115103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist