Provider Demographics
NPI:1356498901
Name:DEL VECCHIO, MARY A (PSYD, CRC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:A
Last Name:DEL VECCHIO
Suffix:
Gender:F
Credentials:PSYD, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 WILSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1706
Mailing Address - Country:US
Mailing Address - Phone:651-233-8036
Mailing Address - Fax:715-684-6776
Practice Address - Street 1:750 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3765
Practice Address - Country:US
Practice Address - Phone:651-233-8036
Practice Address - Fax:715-684-6776
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235026101YM0800X
WI3846-125101YM0800X
MNLPC00915101YM0800X
MNMN00915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIATN65153Medicaid