Provider Demographics
NPI:1831300086
Name:GARY, JUNEAU MAHAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUNEAU
Middle Name:MAHAN
Last Name:GARY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BOWSPRIT DR
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1400
Mailing Address - Country:US
Mailing Address - Phone:732-269-8026
Mailing Address - Fax:732-269-8026
Practice Address - Street 1:32 BOWSPRIT DR
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1400
Practice Address - Country:US
Practice Address - Phone:732-269-8026
Practice Address - Fax:732-269-8026
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00153600101YP2500X
NJ35SI00192700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical