Provider Demographics
NPI:1578784419
Name:TANNEY, MARY FAITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:FAITH
Last Name:TANNEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4545 42ND STREET, NW
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WASHINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:20016-4623
Mailing Address - Country:US
Mailing Address - Phone:202-966-0592
Mailing Address - Fax:202-363-1434
Practice Address - Street 1:4545 42ND STREET, NW
Practice Address - Street 2:SUITE 304
Practice Address - City:WASHINGTON
Practice Address - State:DE
Practice Address - Zip Code:20016-4623
Practice Address - Country:US
Practice Address - Phone:202-966-0592
Practice Address - Fax:202-363-1434
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical