Provider Demographics
NPI:1598901019
Name:STANG, MARY ANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:STANG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COMPTON
Mailing Address - Street 2:UNIT 32
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231
Mailing Address - Country:US
Mailing Address - Phone:513-521-5088
Mailing Address - Fax:513-521-4856
Practice Address - Street 1:800 COMPTON
Practice Address - Street 2:UNIT 32
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231
Practice Address - Country:US
Practice Address - Phone:513-521-5088
Practice Address - Fax:513-521-4856
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103T00000XBehavioral Health & Social Service ProvidersPsychologist