Provider Demographics
NPI:1619193000
Name:REANEY, MARY THERESA (RN MA LIC PSYCHOLOG)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:THERESA
Last Name:REANEY
Suffix:
Gender:F
Credentials:RN MA LIC PSYCHOLOG
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Mailing Address - Street 1:2900 DOGWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-1017
Mailing Address - Country:US
Mailing Address - Phone:610-353-3139
Mailing Address - Fax:610-353-3139
Practice Address - Street 1:31 BISHOP HOLLOW RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073
Practice Address - Country:US
Practice Address - Phone:610-353-3139
Practice Address - Fax:610-353-3139
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAPS006708L103TP2701X
PARN236787L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered163W00000XNursing Service ProvidersRegistered Nurse