Provider Demographics
NPI:1639141088
Name:MALE, MARY ANN MAGEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:MAGEE
Last Name:MALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:MAGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 W CHESTER PIKE
Mailing Address - Street 2:D2
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7778
Mailing Address - Country:US
Mailing Address - Phone:610-692-2092
Mailing Address - Fax:610-692-2863
Practice Address - Street 1:1515 W CHESTER PIKE
Practice Address - Street 2:D2
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7778
Practice Address - Country:US
Practice Address - Phone:610-692-2092
Practice Address - Fax:610-692-2863
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005158L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS005158LOtherLICENSE PSYCHOLOGIST