Provider Demographics
NPI:1619158920
Name:COVERT, MARY BETH (PSYD, ABBP)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:COVERT
Suffix:
Gender:F
Credentials:PSYD, ABBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 PALMYRA RD UNIT 904
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-7044
Mailing Address - Country:US
Mailing Address - Phone:615-988-4462
Mailing Address - Fax:
Practice Address - Street 1:1683 WOODARD RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580
Practice Address - Country:US
Practice Address - Phone:615-988-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical