Provider Demographics
NPI:1558121848
Name:MCCREARY, MARILYN FAYE
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:FAYE
Last Name:MCCREARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 ASPEN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-5309
Mailing Address - Country:US
Mailing Address - Phone:203-570-7811
Mailing Address - Fax:
Practice Address - Street 1:807 ASPEN GLEN DR
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-5309
Practice Address - Country:US
Practice Address - Phone:203-570-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst