Provider Demographics
NPI:1023116209
Name:KATZ, MARY A (MA LPC LMHC CCBT NCC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:KATZ
Suffix:
Gender:F
Credentials:MA LPC LMHC CCBT NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2774
Mailing Address - Country:US
Mailing Address - Phone:508-681-9444
Mailing Address - Fax:
Practice Address - Street 1:222 MAIN ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2774
Practice Address - Country:US
Practice Address - Phone:508-681-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000372101YM0800X
NJ37PC00297000101YP2500X
MA6931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA27-0656453OtherEIN