Provider Demographics
NPI:1922219401
Name:ERNST, MARY ANNE (LMHC MA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNE
Last Name:ERNST
Suffix:
Gender:F
Credentials:LMHC MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MAGNOLIA AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:RI
Mailing Address - Zip Code:32952-4852
Mailing Address - Country:US
Mailing Address - Phone:321-452-0885
Mailing Address - Fax:321-452-0885
Practice Address - Street 1:300 MAGNOLIA AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:MERRITT ISLAND
Practice Address - State:RI
Practice Address - Zip Code:32952-4852
Practice Address - Country:US
Practice Address - Phone:321-452-0885
Practice Address - Fax:321-452-0885
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC1654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health