Provider Demographics
NPI:1497873145
Name:SOLANTO, MARY VICTORIA (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:VICTORIA
Last Name:SOLANTO
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 1:79 HARBOR DR
Mailing Address - Street 2:UNIT 321
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7448
Mailing Address - Country:US
Mailing Address - Phone:212-241-5420
Mailing Address - Fax:
Practice Address - Street 1:MOUNT SINAI MEDICAL CENTER - DEPT OF PSYCH
Practice Address - Street 2:1 GUSTAVE LEVY PLACE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-5420
Practice Address - Fax:212-831-2871
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007122-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical