Provider Demographics
NPI:1902030125
Name:WARD, MARY J (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:WARD
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:BOX 578 WEILL-CORNELL MEDICAL COLLEGE
Mailing Address - Street 2:1300 YORK AVE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0034
Mailing Address - Country:US
Mailing Address - Phone:646-962-6327
Mailing Address - Fax:646-962-0259
Practice Address - Street 1:505 EAST 70 STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0034
Practice Address - Country:US
Practice Address - Phone:646-962-6327
Practice Address - Fax:646-962-0259
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017839103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist