Provider Demographics
NPI:1528189719
Name:CHEYNE, MARY H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:H
Last Name:CHEYNE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:NEW SHOREHAM HUMAN
Other - Middle Name:SYSTEMS CONSULTING,
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:148 EASTERN BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4321
Mailing Address - Country:US
Mailing Address - Phone:860-652-0335
Mailing Address - Fax:860-633-8740
Practice Address - Street 1:148 EASTERN BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4321
Practice Address - Country:US
Practice Address - Phone:860-652-0335
Practice Address - Fax:860-633-8740
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002230103T00000X, 103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent