Provider Demographics
NPI:1598887077
Name:REID, MARY ELLEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELLEN
Last Name:REID
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275
Mailing Address - Street 2:ROUTE 735
Mailing Address - City:MAYFIELD
Mailing Address - State:NEW BRUNSWICK
Mailing Address - Zip Code:E3L 5G1
Mailing Address - Country:CA
Mailing Address - Phone:506-466-1466
Mailing Address - Fax:
Practice Address - Street 1:275
Practice Address - Street 2:ROUTE 735
Practice Address - City:MAYFIELD
Practice Address - State:NEW BRUNSWICK
Practice Address - Zip Code:E3L 5G1
Practice Address - Country:CA
Practice Address - Phone:506-466-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health