Provider Demographics
NPI:1538123880
Name:DRISCOLL, MARY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:S
Last Name:DRISCOLL
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 1:1701 NE 42ND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-5018
Mailing Address - Country:US
Mailing Address - Phone:352-351-4940
Mailing Address - Fax:352-351-8902
Practice Address - Street 1:1701 NE 42ND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-5018
Practice Address - Country:US
Practice Address - Phone:352-351-4940
Practice Address - Fax:352-351-8902
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3809103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73447OtherBCBS
FL73447Medicare ID - Type Unspecified