Provider Demographics
NPI:1184955445
Name:ALLEYNE, MARY ESTELLE (MED ART THERAPY)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ESTELLE
Last Name:ALLEYNE
Suffix:
Gender:F
Credentials:MED ART THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18681 STOEPEL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2250
Mailing Address - Country:US
Mailing Address - Phone:313-443-5607
Mailing Address - Fax:
Practice Address - Street 1:1669 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1230
Practice Address - Country:US
Practice Address - Phone:248-646-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIA450587235841221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist