Provider Demographics
NPI:1669507885
Name:TODORAN, MARY JO (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:
Last Name:TODORAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10355 DAWSONS CREEK BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1903
Mailing Address - Country:US
Mailing Address - Phone:260-438-8200
Mailing Address - Fax:260-490-3160
Practice Address - Street 1:10355 DAWSONS CREEK BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1903
Practice Address - Country:US
Practice Address - Phone:260-438-8200
Practice Address - Fax:260-490-3160
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003556A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical