Provider Demographics
NPI:1619071909
Name:MAUDSLEY, MARY KEADY (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KEADY
Last Name:MAUDSLEY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 N 31ST AVE
Mailing Address - Street 2:A-105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9582
Mailing Address - Country:US
Mailing Address - Phone:602-843-0000
Mailing Address - Fax:602-843-0000
Practice Address - Street 1:10000 N 31ST AVE
Practice Address - Street 2:A-105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9582
Practice Address - Country:US
Practice Address - Phone:602-843-0000
Practice Address - Fax:602-843-0000
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC1262103T00000X
CAMP19615106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist