Provider Demographics
NPI:1972644474
Name:MARY ATWATER, PSY.D., LCC
Entity Type:Organization
Organization Name:MARY ATWATER, PSY.D., LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWATER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-807-8417
Mailing Address - Street 1:5604 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1253
Mailing Address - Country:US
Mailing Address - Phone:301-807-8417
Mailing Address - Fax:
Practice Address - Street 1:4828 WEST LN
Practice Address - Street 2:STE B
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6338
Practice Address - Country:US
Practice Address - Phone:301-807-8417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04053101YM0800X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD491999Medicare ID - Type UnspecifiedMEDICARE