Provider Demographics
NPI:1700826732
Name:DWYER, MARY F (LMF)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:DWYER
Suffix:
Gender:F
Credentials:LMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2343
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-6343
Mailing Address - Country:US
Mailing Address - Phone:508-360-4111
Mailing Address - Fax:
Practice Address - Street 1:57 RT 6A
Practice Address - Street 2:BOARDWALK COMMONS - SECOND FLOOR
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-2409
Practice Address - Country:US
Practice Address - Phone:508-360-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1085106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist