Provider Demographics
NPI:1790792315
Name:HAINES, MARY ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:HAINES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3065 ARLINGTON AVE
Mailing Address - Street 2:UNIVERSITY MEDICAL CENTER REHAB SERVICES
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2570
Mailing Address - Country:US
Mailing Address - Phone:419-383-5040
Mailing Address - Fax:419-383-3184
Practice Address - Street 1:3065 ARLINGTON AVE
Practice Address - Street 2:UNIVERSITY MEDICAL CENTER REHAB SERVICES
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2570
Practice Address - Country:US
Practice Address - Phone:419-383-5040
Practice Address - Fax:419-383-3184
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH5574103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist