Provider Demographics
NPI:1760922421
Name:NOLAN-EATON, MARY KATHERINE
Entity Type:Individual
Prefix:
First Name:MARY KATHERINE
Middle Name:
Last Name:NOLAN-EATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9670
Mailing Address - Country:US
Mailing Address - Phone:717-947-5025
Mailing Address - Fax:
Practice Address - Street 1:6722 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9670
Practice Address - Country:US
Practice Address - Phone:716-947-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health