Provider Demographics
NPI:1417345331
Name:MEHAN, MARY VEIGH (LMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:VEIGH
Last Name:MEHAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:VEIGH
Other - Last Name:MEHAN LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:328 IRISH SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-3106
Mailing Address - Country:US
Mailing Address - Phone:315-386-2016
Mailing Address - Fax:
Practice Address - Street 1:328 IRISH SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-3106
Practice Address - Country:US
Practice Address - Phone:315-386-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health