Provider Demographics
NPI:1558324335
Name:FLOOD, MARY F (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:FLOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 VALLEY ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4844
Mailing Address - Country:US
Mailing Address - Phone:402-483-4571
Mailing Address - Fax:402-483-5079
Practice Address - Street 1:4600 VALLEY ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4844
Practice Address - Country:US
Practice Address - Phone:402-483-4571
Practice Address - Fax:402-483-5079
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE504103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055301101Medicaid
NE47055301101Medicaid
NE272859Medicare ID - Type Unspecified