Provider Demographics
NPI:1437603834
Name:STROUPE, MARY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:STROUPE
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 1:2058 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5746
Mailing Address - Country:US
Mailing Address - Phone:803-645-1926
Mailing Address - Fax:
Practice Address - Street 1:ROOM 161 BLDG 719-5N
Practice Address - Street 2:SAVANNAH RIVER SITE
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29808-0001
Practice Address - Country:US
Practice Address - Phone:803-557-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC000791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical