Provider Demographics
NPI:1710930367
Name:ATWOOD, MARY (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1444
Mailing Address - Country:US
Mailing Address - Phone:941-487-7890
Mailing Address - Fax:
Practice Address - Street 1:4070 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1444
Practice Address - Country:US
Practice Address - Phone:941-487-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2012-02-17
Deactivation Date:2007-08-28
Deactivation Code:
Reactivation Date:2007-11-20
Provider Licenses
StateLicense IDTaxonomies
FLPY8128103TC0700X
NM550103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM62786768Medicaid
NM349615901Medicare PIN